Ibrutinib for a year... then obinutuzumab improves MRD- response rates

[avzuclav]

Ibrutinib and Obinutuzumab in CLL: Improved MRD Response Rates with Substantially Enhanced MRD Depletion for Patients with >1 Year Prior Ibrutinib Exposure

ash.confex.com/ash/2018/web...

Conclusions: The results suggest that the addition of obinutuzumab to ibrutinib may result in a substantial improvement in the depletion of CLL cells from the PB and BM for ibrutinib-naïve patients. However, a greater impact in MRD response rate and depth of depletion was seen when obinutuzumab was introduced after >1 year of ibrutinib treatment and tumour bulk was low. For patients with persistent disease during/ following pathway inhibition treatments, the addition of anti-CD20 antibody therapy may be effective at improving MRD response rates.

[Tom8O]

This combination was approved by the FDA in January for frontline treatment. Haven’t been able to find much in these forums about this combination.

mdmag.com/medical-news/fda-...

Should those of us on Ibrutinib as frontline treatment be thinking about adding Gazyva?

Thanks,

Tom

[may04cll in reply to Tom8O]

that's a question for a Cll specialist , one who was experience with both drugs not your ordinary local community oncologist / hematologist

[avzuclav]

Additional data from iwCLL 2019 on pages 16, 17 and 18 of this pdf:

iwcll2019.org/wp-content/up...

• CD20 expression decreases during first 6 months of ibrutinib exposure, nadir at month 1 with expression increasing after month 9

Disease bulk pre-obinituzumab is lower in the ibrutinib-exposed cohort vs. IBRnaïve:

• Lymphadenopathy: 0% vs. 87%

• BM CLL involvement: 43% vs 80%

youtube.com/watch?v=e0fGT-i...(Not working as expected?)

[avzuclav]

Update from ASH 2020:

Ibrutinib and Obinutuzumab in CLL: MRD Responses Sustained for Several Years with Deepest MRD Depletion in Patients with >1 Year Prior Ibrutinib Exposure

"Conclusions: The addition of OBI to IBR may substantially improve depletion of CLL cells from the PB and BM. A greater impact in MRD response rate and depth was seen when OBI was introduced after >1 year of IBR treatment and tumour bulk was low. One fifth of patients maintain <0.01% MRD up to 3 years after combined IBR+OBI, demonstrating that response improvements associated with OBI are sustainable in some cases."

ash.confex.com/ash/2020/web...