Timofeeva Natalia, Jain Nitin, Gandhi Varsha
Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX.
Blood Neoplasia. 2024 Sep;1(3). doi: 10.1016/j.bneo.2024.100034. Epub 2024 Aug 1.
The combination of ibrutinib and venetoclax has emerged as a promising therapeutic strategy for patients with chronic lymphocytic leukemia (CLL). Preclinical investigations demonstrated a synergistic antitumor effect through multiple mechanisms, providing a robust foundation for translating this regimen into clinical trials. Beyond the dual inhibition by 2 small molecules, another innovative concept being tested with this combination is the use of measurable residual disease (MRD)-driven treatment vs fixed-duration treatment to meet the escalating demand for oral, convenient, cost-effective, and time-limited therapeutic approaches. The clinical translation of this combination has yielded remarkable outcomes with significant improvements in the progression-free survival and overall survival rates for both treatment-naïve patients and those with relapsed/refractory CLL. Notably, a substantial proportion of patients achieved undetectable MRD. Clinical trial updates following the initial published results have shown consistency and durability of responses over time. In this review, the initial investigator-initiated trial results for ibrutinib and venetoclax are discussed, several multicenter clinical trial designs and outcomes are examined, variables such as chromosome 17p deletion that influence treatment responses are addressed, and the safety of the regimen is discussed. In addition, we reviewed the usage of this combination in other B-cell malignancies and discussed how current knowledge can be used for shaping the future CLL treatment regimens.
伊布替尼与维奈克拉联合使用已成为慢性淋巴细胞白血病(CLL)患者一种有前景的治疗策略。临床前研究通过多种机制证明了其协同抗肿瘤作用,为将该方案转化为临床试验奠定了坚实基础。除了这两种小分子的双重抑制作用外,用这种联合方案正在测试的另一个创新概念是使用可测量残留病(MRD)驱动的治疗与固定疗程治疗,以满足对口服、方便、经济高效且限时治疗方法不断增长的需求。这种联合方案的临床转化取得了显著成果,初治患者和复发/难治性CLL患者的无进展生存率和总生存率均有显著提高。值得注意的是,相当一部分患者实现了MRD不可检测。在最初发表结果后的临床试验更新显示,随着时间推移,反应具有一致性和持久性。在本综述中,讨论了伊布替尼和维奈克拉最初由研究者发起的试验结果,研究了几个多中心临床试验设计和结果,探讨了影响治疗反应的变量如17号染色体p缺失等,并讨论了该方案的安全性。此外,我们回顾了这种联合方案在其他B细胞恶性肿瘤中的应用,并讨论了如何利用现有知识来制定未来的CLL治疗方案。