Combination therapy key in two studies of blood cancers likely to relapse
BY Ron Gilmore
December 06, 2019
Medically Reviewed | Last reviewed by an MD Anderson Cancer Center medical professional on December 06, 2019
Results from two MD Anderson studies demonstrated the significance of combination therapy in follicular lymphoma and chronic lymphoblastic leukemia , two blood cancers that often result in relapse after first treatments. Initial findings for both will be presented this weekend at the 61st American Society of Hematology Annual Meeting & Exposition (ASH).
Abstract 125: Results of a phase II study of obinutuzumab in combination with lenalidomide in previously untreated, high-tumor burden follicular Lymphoma (FL)
This phase II study looked at the monoclonal antibody obinutuzumab combined with lenalidomide for treating patients with high tumor burden who had received no previous therapy. Prior MD Anderson-led studies showed this combo effective for patients with relapsed follicular lymphoma.
“Obinutuzumab therapy resulted in very high overall response rates of 98% and complete remission of 92%, “said Loretta Nastoupil, M.D., associate professor of Lymphoma & Myeloma. “We also reported a two-year progression free survival of 96% with manageable side effects.”
Follicular lymphoma is the most common indolent non-Hodgkin lymphoma, and is characterized by a defective immune microenvironment that suppresses normal T-cell and natural-killer (NK)-cell activity. Often there are high initial response rates followed by repeated relapses with most patients succumbing to the cancer.
Abstract 358: Venetoclax added to ibrutinib in high-risk CLL achieves a high rate of undetectable minimal residual disease.
This phase II study combined two therapies, ibrutinib and venetoclax, for patients with high-risk chronic lymphoblastic leukemia.
“Venetoclax with ibrutinib was well-tolerated and associated with a 67% likelihood of achieving undetectable minimal residual disease and complete remission within one year of the combo therapy,” said Philip Thompson, M.B.B.S., associate professor of Leukemia. Time-limited therapy may be feasible in high-risk CLL patients but further follow up is needed.”
CLL patients receiving ibrutinib rarely achieve complete remission with undetectable minimal residual disease and require indefinite suppressive therapy. This results in a cumulative risk of relapse and also of adverse events leading to drug discontinuation.