In:
Frontiers in Oncology, Frontiers Media SA, Vol. 12 ( 2022-11-21)
Kurzfassung:
One of the main issues in the treatment of patients with chronic lymphocytic leukemia (CLL) deals with the choice between continuous or fixed-duration therapy. Continuous ibrutinib (IB), the first-in-class BTK inhibitor, and obinutuzumab-chlorambucil (G-CHL) are commonly used therapies for elderly and/or comorbid patients. No head-to-head comparison has been carried out. Within the Italian campus CLL network, we performed a retrospective study on CLL patients without TP53 disruption treated with IB or G-CHL as first-line therapy. Patients in the G-CHL arm had a higher CIRS score and the worst renal function. The overall response rates between the G-CHL and IB arms were similar, but more complete remissions (CRs) were achieved with G-CHL ( p = 0.0029). After a median follow-up of 30 months, the progression-free survival (PFS, p = 0.0061) and time to next treatment (TTNT, p = 0.0043), but not overall survival (OS, p = 0.6642), were better with IB than with G-CHL. Similar results were found after propensity score matching and multivariate analysis. While PFS and TTNT were longer with IB than with G-CHL in IGHV unmutated patients ( p = 0.0190 and 0.0137), they were superimposable for IGHV mutated patients ( p = 0.1900 and 0.1380). In the G-CHL arm, the depth of response (79% vs . 68% vs . 38% for CR, PR and SD/PD; p & lt; 0.0001) and measurable residual disease (MRD) influenced PFS (78% vs . 53% for undetectable MRD vs . detectable MRD, p = 0.0203). Hematological toxicities were common in the G-CHL arm, while IB was associated with higher costs. Although continuous IB provides better disease control in CLL, IGHV mutated patients and those achieving an undetectable MRD show a marked clinical and economic benefit from a fixed-duration obinutuzumab-based treatment.
Materialart:
Online-Ressource
ISSN:
2234-943X
DOI:
10.3389/fonc.2022.1033413
DOI:
10.3389/fonc.2022.1033413.s001
Sprache:
Unbekannt
Verlag:
Frontiers Media SA
Publikationsdatum:
2022
ZDB Id:
2649216-7
