固定疗程哌泊溴烷联合维奈托克,或联合利妥昔单抗,治疗复发/难治性 CLL:BRUIN 研究 1b 期试验。

Fixed-duration pirtobrutinib plus venetoclax with or without rituximab in relapsed/refractory CLL: the phase 1b BRUIN trial.

机构信息

Memorial Sloan Kettering Cancer Center, New York, NY.

The Ohio State University Comprehensive Cancer Center, Columbus, OH.

出版信息

Blood. 2024 Sep 26;144(13):1374-1386. doi: 10.1182/blood.2024024510.

Abstract

Pirtobrutinib is a highly selective, noncovalent (reversible) Bruton tyrosine kinase inhibitor (BTKi). Patients with relapsed or refractory (R/R) chronic lymphocytic leukemia (CLL) were treated with fixed-duration pirtobrutinib plus venetoclax (PV) or pirtobrutinib plus venetoclax and rituximab (PVR) in this phase 1b trial. Prior covalent BTKi therapy was allowed, but not prior treatment with venetoclax. Patients were assigned to receive PV (n = 15) or PVR (n = 10) for 25 cycles. Most patients (68%) had received prior covalent BTKi therapy. At the data cutoff date, the median time on study was 27.0 months for PV and 23.3 months for PVR. Overall response rates were 93.3% (95% confidence interval [CI], 68.1-99.8) for PV and 100% (95% CI, 69.2-100.0) for PVR, with 10 complete responses (PV: 7; PVR: 3). After 12 cycles of treatment, 85.7% (95% CI, 57.2-98.2) of PV and 90.0% (95% CI, 55.5-99.7) of PVR patients achieved undetectable minimal residual disease (<10-4) in peripheral blood. Progression-free survival at 18 months was 92.9% (95% CI, 59.1-99.0) for PV patients and 80.0% (95% CI, 40.9-94.6) for PVR patients. No dose-limiting toxicities were observed during the 5-week assessment period. The most common grade ≥3 adverse events (AEs) for all patients included neutropenia (52%) and anemia (16%). AEs led to dose reduction in 3 patients and discontinuation in 2. In conclusion, fixed-duration PV or PVR was well tolerated and had promising efficacy in patients with R/R CLL, including patients previously treated with a covalent BTKi. This trial was registered at www.clinicaltrials.gov as #NCT03740529.

摘要

泊鲁替尼是一种高选择性、非共价(可逆)布鲁顿酪氨酸激酶抑制剂(BTKi)。在这项 1b 期试验中,复发或难治性(R/R)慢性淋巴细胞白血病(CLL)患者接受了固定疗程的泊鲁替尼联合维奈托克(PV)或泊鲁替尼联合维奈托克和利妥昔单抗(PVR)治疗。允许患者既往接受共价 BTKi 治疗,但不允许既往接受维奈托克治疗。患者被分配接受 PV(n=15)或 PVR(n=10)治疗 25 个周期。大多数患者(68%)既往接受过共价 BTKi 治疗。在数据截止日期时,PV 的中位研究时间为 27.0 个月,PVR 的中位研究时间为 23.3 个月。PV 的总缓解率为 93.3%(95%CI,68.1-99.8),PVR 的总缓解率为 100%(95%CI,69.2-100.0),10 例完全缓解(PV:7 例;PVR:3 例)。治疗 12 个周期后,85.7%(95%CI,57.2-98.2)的 PV 患者和 90.0%(95%CI,55.5-99.7)的 PVR 患者在外周血中达到可检测的微小残留病灶<10-4。PV 患者的 18 个月无进展生存率为 92.9%(95%CI,59.1-99.0),PVR 患者的 18 个月无进展生存率为 80.0%(95%CI,40.9-94.6)。在 5 周评估期间,未观察到剂量限制毒性。所有患者中最常见的≥3 级不良事件(AE)包括中性粒细胞减少症(52%)和贫血(16%)。3 例患者因 AE 减少剂量,2 例患者因 AE 停药。总之,固定疗程的 PV 或 PVR 耐受性良好,在复发/难治性 CLL 患者中具有良好的疗效,包括既往接受共价 BTKi 治疗的患者。该试验在 www.clinicaltrials.gov 上注册为 #NCT03740529。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e116/11451378/e53eaf32086b/BLOOD_BLD-2024-024510-ga1.jpg

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