MD Anderson Cancer Center, Houston, Texas.
Florida Cancer Specialists, Sarasota, Florida.
Am J Hematol. 2018 Nov;93(11):1318-1326. doi: 10.1002/ajh.25243. Epub 2018 Oct 20.
Duvelisib (IPI-145), an oral, dual inhibitor of phosphoinositide-3-kinase (PI3K)-δ and -γ, was evaluated in a Phase 1 study in advanced hematologic malignancies, which included expansion cohorts in relapsed/refractory (RR) chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) and treatment-naïve (TN) CLL. Per protocol, TN patients were at least 65 years old or had a del(17p)/TP53 mutation. Duvelisib was administered twice daily (BID) in 28-day cycles at doses of 8-75 mg in RR patients (n = 55) and 25 mg in TN patients (n = 18.) Diarrhea was the most common nonhematologic AE (TN 78%, RR 47%); transaminase elevations the most frequent lab-abnormality AE (TN 33.3%, RR 30.9%); and neutropenia the most common ≥grade 3 AE (RR 44%, TN 33%). The overall response rates were 56.4% for RR patients (1.8% CR, 54.5% PR) and 83.3% for TN patients (all PRs); median response duration was 21.0 months in RR patients but was not reached for TN patients. Based upon phase 1 efficacy, pharmacodynamics, and safety, duvelisib 25 mg BID was selected for further investigation in a phase 3 study in RR CLL/SLL.
杜韦利昔布(IPI-145)是一种口服、双重磷酸肌醇 3-激酶(PI3K)-δ 和 -γ抑制剂,在晚期血液恶性肿瘤的 1 期研究中进行了评估,该研究包括复发/难治性(RR)慢性淋巴细胞白血病(CLL)/小淋巴细胞淋巴瘤(SLL)和初治(TN)CLL 的扩展队列。根据方案,TN 患者年龄至少为 65 岁或存在 del(17p)/TP53 突变。RR 患者接受 8-75mg 剂量的杜韦利昔布每日两次(BID)给药,28 天为一个周期(n=55),TN 患者接受 25mg 剂量的杜韦利昔布(n=18)。腹泻是最常见的非血液学不良事件(TN 为 78%,RR 为 47%);转氨酶升高是最常见的实验室异常不良事件(TN 为 33.3%,RR 为 30.9%);中性粒细胞减少是最常见的≥3 级不良事件(RR 为 44%,TN 为 33%)。RR 患者的总缓解率为 56.4%(1.8%CR,54.5%PR),TN 患者为 83.3%(均为 PR);RR 患者的中位缓解持续时间为 21.0 个月,但 TN 患者未达到。基于 1 期疗效、药效学和安全性,选择杜韦利昔布 25mg BID 用于 RR CLL/SLL 的 3 期研究。