Expanding beyond the chronic lymphocytic leukemia/ small lymphocytic lymphoma space, the BCL2 inhibitor venetoclax garnered attention durante 2020 for positive reports from phase 3 clinical trials exploring its use mediante acute myeloid leukemia and multiple myeloma.
Expanding beyond the chronic lymphocytic leukemia/ small lymphocytic lymphoma space, the BCL2 inhibitor venetoclax (Venclexta) garnered attention mediante 2020 for positive reports from phase 3 clinical trials exploring its use sopra acute myeloid leukemia (AML) and multiple myeloma.
“A large [number] of patients with AML, including those [75 years or older] or those who have medical comorbidities, cannot tolerate existing treatment strategies, and the patients with AML who are ineligible for intensive chemotherapy often experience poor prognoses,” Courtney D. DiNardo, MD, MCSE, lead investigator and an associate professor per the Department of Leukemia at The University of Texas MD Anderson Cancer Center durante Houston, said con verso news release. 4 “We launched the Strada-Verso trial esatto evaluate whether we could safely use a combination therapy esatto treat this critical patient population.”
The trial met its primary end point of overall survival (OS) superiority with venetoclax www.datingranking.net/it/hookupdate-review. The median OS was 14.7 months for the venetoclax group and 9.6 months with placebo, which represents a 34% reduction in the risk of death (HR, 0.66; 95% CI, 0.52-0.85; P < .001).>
Venetoclax also improved complete remission (CR) rates, which represented a key secondary end point. Corresponding rates of CR were 36.7% versus 17.9% (P < .001);>
Notable hematologic adverse events with venetoclax included thrombocytopenia, neutropenia, febrile neutropenia, debolezza, and leukopenia. Discontinuation rates were similar mediante the venetoclax and placebo arms (24% vs 20%). Ritaglio interruptions esatto allow for hematologic recovery occurred more frequently with venetoclax (TABLE 1 3 ).
“Key management guidelines include dosing interruptions between cycles preciso allow for count recovery durante the setting of a leukemia-free marrow and the use of granulocyte colony-stimulating factor as an adjunct esatto improve neutrophil count once per patient is mediante remission,” DiNardo said.
Supportive care for patients receiving the venetoclax regimen, such as prophylactic antimicrobial agents, was recommend by the investigators. It was noted that there were giammai differences con quality-of-life measures between the 2 groups.
Myeloma Combinations With Venetoclax Mediante BELLINI, patients with relapsed/refractory multiple myeloma who had received 1 esatto 3 prior therapies were randomly assigned preciso bortezomib and dexamethasone plus either placebo (n = 97) or venetoclax (n = 194). 2
Median progression-free survival (PFS), the trial’s primary end point, was significantly improved with venetoclax at 22.4 months versus 11.5 months with placebo (HR, 0.63; 95% CI, 0.44-0.90; P = .01).
Despite the positive efficacy findings, troubling treatment-related mortality datazione emerged. Eight (4%) treatment-emergent fatal infections were reported with venetoclax, and 3 deaths were concluded puro be related preciso treatment. However, neither event was noted con the placebo group. These concerning findings elevated the importance of identifying patient subsets who derive the greatest benefit from this therapy regimen.
Subgroup analyses identified patient groups with distinct efficacy outcome improvement. Response rates were better sopra patients who had high BCL2 expression or t(11;14) translocation (TABLE 2 2 ), and these responses were some of the best and most durable ever reported mediante phase 3 trials examining triplet therapies for multiple myeloma, the investigators said.
Considerations for Care
Looking at the composite results of these trials, the evidence suggest that venetoclax may be verso valuable tool per the broader precision medicine paradigm per specific hematologic cancer population subsets.
Notably, the investigators on BELLINI reviewed why the agent was particularly effective con patients with a specific cytogenetic profile. “Most of the existing therapies for multiple myeloma target cellular mechanisms that are crucial esatto plasma cells broadly, rather than targeting changes unique to malignant myeloma cells,” wrote the investigators led by Shaji K. Kumar, MD, of Mayo Clinic con Rochester, Minnesota. “Venetoclax, by virtue of its mechanism of action, is more effective against multiple myeloma cells that are more dependent on BCL2 for survival. BCL2 dependency varies between patients and is affected by BCL2 protein family member expression and the presence of genetic abnormalities, such as t(11;14) translocation, thus offering the opportunity preciso develop per personalized treatment strategy durante multiple myeloma.”
Another phase 1/2 study (NCT01794520), which was reported at the 2019 American Society of Hematology Annual Congresso & Exposition, showed similarly positive results with the combination of venetoclax and dexamethasone in patients with multiple myeloma and translocation t(11;14), where 35% of patients had verso very good partial response or better. These results were recorded in a cohort that included a majority of patients who were refractory puro daratumumab (Darzalex). 5
Venetoclax Makes Inroads Into More Hematologic Setting
The phase 3 CAining venetoclax and dexamethasone durante patients with relapsed/refractory myeloma, this time with per comparator arm of pomalidomide (Pomalyst) and dexamethasone.
Sopra AML, the placement of venetoclax mediante the frontline setting offers an optimal treatment option puro those who formerly had few options, but this treatment approach is still evolving.
“While this combination represents per key advance per AML therapy, improving both remission and survival rates sopra newly diagnosed patients with AML, many unfortunately will still relapse,” DiNardo said. “Our next steps include an evaluation of azacitidine and venetoclax as a backbone esatto which additional novel therapeutics are being evaluated per particularly high-risk populations.”
2. Kumar SK, Harrison SJ, Gomena M, et al. Venetoclax or placebo sopra combination with bortezomib and dexamethasone mediante patients with relapsed or refractory multiple myeloma (BELLINI): verso randomised, double-blind, multicentre, phase 3 trial. Lancet Oncol. Published online . doi:/S1470-2045(20)30525-8
3. DiNardo CD, Jonas BA, Pullarkat V, et al. Azacitidine and venetoclax mediante previously untreated acute myeloid leukemia. N Engl J Med. 2020;383(7):617-629. doi:/ NEJMoa2012971
4. Combination therapy significantly improves survival outcomes for patients with acute myeloid leukemia. News release. The University of Texas MD Anderson Cancer Center. .
5. Kaufman JL, Gasparetto C, Schjesvold FH, et al. Phase I/II study evaluating the safety and efficacy of venetoclax con combination with dexamethasone as targeted therapy for patients with tau(11;14) relapsed/refractory multiple myeloma. Blood. 2019;134(suppl 1):926. doi:/blood-2019-125871