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LBA-6 A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study Evaluating the Efficacy and Safety of Idelalisib and Rituximab for Previously Treated Patients with Chronic Lymphocytic Leukemia (CLL)

Program: General Sessions
Session: Late-Breaking Abstracts Session
Tuesday, December 10, 2013, 7:30 AM-9:00 AM
Hall F (Ernest N. Morial Convention Center)

Richard R. Furman, MD1, Jeff P. Sharman, MD2, Steven E. Coutre, MD3, Bruce D. Cheson, MD4, John M. Pagel, MD, PhD5, Peter Hillmen, MBChB, PhD6, Jacqueline C. Barrientos, MD7, Andrew D. Zelenetz, MD, PhD8, Thomas J. Kipps, MD, PhD9, Ian Flinn, MD, PhD10, Paolo Ghia, MD, PhD11, Herbert Eradat, MD12, Thomas Ervin, MD13*, Nicole Lamanna, MD8, Michael Hallek, MD14, Bertrand Coiffier, MD, PhD15, Andrew R. Pettitt, PhD, FRCPath16*, Shuo Ma, MD, PhD17, Stephan Stilgenbauer, MD18, Paula Cramer, MD14*, Maria Aiello19*, Dave M. Johnson19, Langdon L. Miller, MD19*, Daniel Li, PhD19*, Thomas M. Jahn, MD, PhD19, Roger D. Dansey, MD19* and Susan M. O'Brien, MD20

1Weill Cornell Medical College, New York, NY
2US Oncology Research, Springfield, OR
3Stanford University School of Medicine, Stanford, CA
4Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
5Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
6St. James's University Hospital, Leeds, United Kingdom
7Department of Medicine, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY
8Memorial Sloan-Kettering Cancer Center, New York, NY
9University of California San Diego, Moores Cancer Center, La Jolla, CA
10Sarah Cannon Research Institute, Nashville, TN
11Universita Vita-Salute San Raffaele, Instituto Scientifico San Raffaele, Milano, Italy
12David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
13Florida Cancer Specialists, Englewood, FL
14University of Cologne, Cologne, Germany
15Centre Hospitalier Lyon-Sud, Pierre-Benite, France
16Royal Liverpool University Hospital, Liverpool, United Kingdom
17Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
18University of Ulm, Ulm, Germany
19Gilead Sciences, Inc., Foster City, CA
20University of Texas MD Anderson Cancer Center, Houston, TX

Background: Idelalisib (IDELA) is a first-in-class, selective, oral inhibitor of PI3Kδ that reduces proliferation, enhances apoptosis, and inhibits homing and retention of malignant B cells in lymphoid tissues. Phase 1 trials demonstrated that IDELA is highly active as a single agent or in combination with rituximab (R) in heavily pretreated patients (pts) with CLL. Pts in these trials experienced reductions in disease-associated chemokines, improvement of organomegaly and cytopenias, profound reductions in lymphadenopathy, and durable clinical benefit with an acceptable safety profile (Brown 2013; Barrientos 2013). Patients with early progression and significant co-morbidities have limited treatment options; single-agent rituximab is an option in these pts (NCCN 2013; Zelenetz 2013).

Methods: This Phase 3 study evaluated the efficacy and safety of IDELA + R vs placebo + R in pts with previously treated CLL. Eligibility criteria included the need for treatment per IWCLL guidelines, measurable lymphadenopathy, and CLL progression <24 mos since the completion of last therapy. Pts were considered unfit to receive cytotoxic therapy because of comorbidities (defined as a Cumulative Illness Rating Score [CIRS] > 6), renal dysfunction, or cytopenias due to poor marrow reserve. All pts received R at 375 mg/m2 [1st dose] and then 500 mg/m2q2 wks x 4, followed by q4 wks x 3 [8 doses total]) and were randomized to Arm A (n=110; IDELA 150 mg BID continuously) or Arm B (n=110; placebo BID continuously). Primary endpoint was progression-free survival (PFS). Response and progression in both arms were assessed by an independent review committee using standard criteria (Hallek 2008; Cheson 2012). Results were reviewed by an external Data Monitoring Committee (DMC).

Results: Results are from a pre-specified interim analysis after ~50% of the total number of 119 planned events of CLL progression or death from any cause. Data cutoff was 30 Aug 2013. Pt characteristics (n=220) included a median age of 71 yrs (78% ≥ 65 yrs); CIRS > 6 in 85%; median creatinine clearance of 63.6 mL/min; and presence of anemia (73%), thrombocytopenia (61%), neutropenia (34%). Median time since diagnosis was 8.5 yrs, median number of prior therapies was 3 (range: 1-12), 44% had del(17p)/TP53 mutation, and 84% had unmutated IGHV. PFS in the IDELA + R arm was superior to placebo +R (HR [95% CI] = 0.15 [0.08, 0.28]; p = 3.0 x 1011). Median PFS of pts treated with IDELA + R was not reached and for placebo + R was 5.5 mos. At 24 wks, the PFS rate for IDELA +R was 93% compared to 46% for placebo + R. PFS strongly favored IDELA + R in all subgroups, including those with del(17p)/TP53 or unmutated IGHV. Pts treated with IDELA + R and with ≥1 post-baseline assessment also had a superior overall response rate (ORR) relative to those in the control arm (81% vs. 13%; odds ratio 29.9; p = 3.0 x 10‑19) and a higher lymph node response (LNR) rate (93% vs. 4%; odds ratio 264.5; p = 1.3 x 10-30). Relative to the control group, pts treated with IDELA +R also had a significant improvement in overall survival (OS): HR (95% CI) = 0.28 (0.09, 0.86), p = 0.018.

Adverse events (AEs) occurring in ≥20% of pts (any Gr/Gr ≥3) by arm were: pyrexia (IDELA + R 29%/3%; placebo + R 16%/1%), fatigue (IDELA + R 24%/3%; placebo + R 27%/2%), nausea (IDELA + R 24%/0%; placebo + R 22%/0%), chills (IDELA + R 22%/2%; placebo + R 16%/0%), infusion-related reactions (IDELA + R 16%/0%; placebo + R 28%/4%), and cough (IDELA + R 15%/0%; placebo + R 25%/2%). Other selected AEs (any Gr/Gr ≥3) included diarrhea (IDELA + R 19%/4%; placebo + R 14%/0%) and rash (IDELA + R 10%/2%; placebo + R 6%/0%). Select lab abnormalities (any Gr/Gr ≥3) included ALT elevation (IDELA + R 31%/6%; placebo + R 9%/1%), anemia (IDELA + R 26%/6%; placebo + R 30%/14%), neutropenia (IDELA + R 55%/34%; placebo + R 49%/22%), and thrombocytopenia (IDELA + R 17%/10%; placebo + R 26%/16%). The most common SAEs were pneumonia (6.4%), pyrexia (6.4%), and febrile neutropenia (4.5%) in IDELA + R, and pneumonia (8.4%), febrile neutropenia (5.6%), and dyspnea (3.7%) in placebo + R. AEs led to study drug discontinuation in 9 pts (8.2%) in IDELA + R and 11 pts (10.3%) in placebo + R.

Based on a review of efficacy and safety, the DMC recommended stopping the study early.

Conclusions: IDELA + R demonstrated statistically significant improvement with acceptable safety over placebo + R in PFS, ORR, LNR and OS in heavily pretreated pts with relapsed CLL, including those with adverse genetic features.

Disclosures: Furman: Gilead Sciences: Membership on an entity’s Board of Directors or advisory committees, Research Funding. Sharman: Gilead Sciences: Consultancy, Research Funding. Coutre: Gilead Sciences: Research Funding. Cheson: Gilead Sciences: Research Funding. Pagel: Gilead Sciences: Research Funding. Hillmen: Gilead Sciences: Research Funding. Barrientos: Gilead Sciences: Research Funding. Zelenetz: Gilead Sciences: Membership on an entity’s Board of Directors or advisory committees, Research Funding. Kipps: Gilead Sciences: Research Funding. Flinn: Gilead Sciences: Research Funding. Ghia: Gilead Sciences: Membership on an entity’s Board of Directors or advisory committees, Research Funding. Eradat: Gilead Sciences: Research Funding. Ervin: Gilead Sciences: Research Funding. Lamanna: Gilead Sciences: Research Funding. Hallek: Gilead Sciences: Research Funding. Coiffier: Gilead Sciences: Research Funding. Pettitt: Gilead Sciences: Research Funding. Ma: Gilead Sciences: Research Funding. Stilgenbauer: Gilead Sciences: Honoraria, Research Funding. Aiello: Gilead Sciences: Employment. Johnson: Gilead Sciences: Employment, Equity Ownership. Miller: Gilead Sciences: Employment, Equity Ownership. Li: Gilead Sciences: Employment. Jahn: Gilead Sciences: Employment. Dansey: Gilead Sciences: Employment, Equity Ownership. O'Brien: Gilead Sciences: Research Funding.

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