First-line acalaburitnib plus obinutuzmumab prolongs progression-free survival (PFS) compared to ibrutinib-obinutuzumab and venetoclax-obinutuzumab for patients with chronic lymphocytic leukemia (CLL), according to a study published in Clinical Lymphoma, Myeloma, & Leukemia (2020;S2152-265[20]30579-6).
“Available targeted agents for the upfront therapy of chronic lymphocytic leukemia (ie, ibrutinib, acalabrutinib, venetoclax) have rarely been compared in head-to-head clinical trials,” explained Stefano Molic, MD, Azienda Ospedaliera Pugliese-Ciaccio, Italy, and colleagues, who performed this literature review and meta-analysis.
The base-case network analysis included 3 trials: ILLUMINATE, ELEVATE-TN, and CLL14.
No significant differences in PFS were observed in fixed analyses comparing ibrutinib-obinutuzumab with venetoclax-obinutuzumab (relative risk [RR], 1.52; 95% confidence interval [CI], 0.82-2.81), acalabrutinib monotherapy with ibrutinib-obinutuzumab (RR, 0.87; 95% CI, 0.47-1.61), and acalabrutinib monotherapy with venetoclax-obinutuzumab (RR, 0.57; 95% CI, 0.32-1.01).
However, acalabrutinib plus obinutuzumab demonstrated improved PFS in comparison with ibrutinib-obinutuzumab (RR, 0.43; 95% CI, 0.22-0.87) and venetoclax-obinutuzumab (RR, 0.29; 95% CI, 0.15-0.56).
Dr Molic and colleagues reported that across the targeted agents, no differences in the frequency of adverse events were observed.
“This systematic review and network meta-analysis indicated that upfront AO [acalabrutinib-obinutuzumab] prolongs PFS in comparison with IO [ibrutinib-obinutuzumab] and VO [venetoclax-obinutuzumab], whereas no differences are observed between IO, VO, and single-agent A,” Dr Molic and colleagues concluded.
“Hopefully, ongoing studies will further delineate the position of different TAs in chronic lymphocytic leukemia therapy based on effectiveness, availability, safety, cost, and treatment objectives,” they added.—Janelle Bradley
