Department of Internal Medicine III, Ulm University, Ulm and Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg, Germany.
Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain.
Br J Haematol. 2021 Apr;193(2):325-338. doi: 10.1111/bjh.17326. Epub 2021 Feb 19.
The manageable toxicity profile of obinutuzumab (GA101; G) alone or with chemotherapy in first-line (1L; fit and non-fit) and relapsed/refractory (R/R) patients with chronic lymphocytic leukaemia (CLL) was established in the primary analysis of the Phase IIIb GREEN trial (Clinicaltrials.gov: NCT01905943). The final analysis (cut-off, 31 January 2019) is reported here. Patients received G (1000 mg) alone (G-mono; fit and non-fit patients) or with chemotherapy [fludarabine and cyclophosphamide (FC; fit patients); chlorambucil (non-fit patients); bendamustine (any patient)]. Study endpoints were safety (primary) and efficacy (secondary). Subgroup analyses were performed on prognostic biomarkers in 1L CLL. Overall, 630 patients received 1L and 341 received R/R CLL treatment. At the final analysis, no new safety signals were observed [Grade ≥ 3 adverse events (AEs): 1L 82·7%, R/R 84·5%; serious AEs: 1L 58·1%, R/R 62·5%]. Neutropenia (1L 50·5%, R/R 53·4%) and thrombocytopenia (1L 14·6%, R/R 19·1%) were the most common Grade 3-5 AEs. G-mono-, G-bendamustine and G-FC-treated patients with unmutated immunoglobulin heavy chain trended towards shorter progression-free survival. Achievement of minimal residual disease negativity was greatest in 1L patients treated with G-FC. In this final analysis of the GREEN trial, the safety profile of G was consistent with current risk management strategies. Biomarker analyses supported efficacy in the specific subgroups.
奥滨尤妥珠单抗(GA101;G)单药或联合化疗在初治(1L;适合和不适合)和复发/难治(R/R)慢性淋巴细胞白血病(CLL)患者中的可管理毒性特征已在 IIIb 期 GREEN 试验的主要分析中确立(Clinicaltrials.gov:NCT01905943)。这里报告最终分析(截止日期,2019 年 1 月 31 日)。患者接受 G(1000mg)单药(G 单药;适合和不适合的患者)或联合化疗[氟达拉滨和环磷酰胺(FC;适合的患者);苯丁酸氮芥(不适合的患者);苯达莫司汀(任何患者)]。研究终点为安全性(主要)和疗效(次要)。在 1L CLL 中对预后生物标志物进行了亚组分析。总体而言,630 例患者接受了 1L 治疗,341 例患者接受了 R/R CLL 治疗。在最终分析时,未观察到新的安全性信号[1L 级≥3 不良事件(AE):82.7%,R/R 84.5%;严重 AE:1L 58.1%,R/R 62.5%]。中性粒细胞减少症(1L 50.5%,R/R 53.4%)和血小板减少症(1L 14.6%,R/R 19.1%)是最常见的 3-5 级 AE。未突变免疫球蛋白重链的 G 单药、G-苯达莫司汀和 G-FC 治疗患者的无进展生存期更短。1L 接受 G-FC 治疗的患者实现微小残留病阴性的比例最高。在 GREEN 试验的最终分析中,G 的安全性与当前的风险管理策略一致。生物标志物分析支持特定亚组的疗效。