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470 Ibrutinib Plus Rituximab in Treatment-Naive Patients with Follicular Lymphoma: Results from a Multicenter, Phase 2 Study

Lymphoma: Therapy with Biologic Agents, excluding Pre-Clinical Models
Program: Oral and Poster Abstracts
Type: Oral
Session: 624. Lymphoma: Therapy with Biologic Agents, excluding Pre-Clinical Models: Biologic Agents in B Cell Lymphoma
Monday, December 7, 2015: 7:15 AM
Hall E2, Level 2 (Orange County Convention Center)

Nathan Fowler, MD1, Loretta Nastoupil, MD2, Sven de Vos, MD, PhD3, Mark Knapp, MD4, Ian W. Flinn, MD, PhD5, Robert Chen6, Ranjana H Advani, MD7, Sumeet Bhatia, MD8*, Peter Martin, MD9, Raul Mena, MD10, Samuel Suzuki, MS, MBA11*, Darrin M. Beaupre, MD11, Jutta K. Neuenburg, MD11* and M. Lia Palomba, MD12

1Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
2University of Texas MD Anderson Cancer Center, Houston, TX
3Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
4Mid Ohio Oncology/Hematology, Inc., Columbus, OH
5Hematologic Malignancies Research Program, Sarah Cannon Research Institute, Nashville, TN
6City of Hope National Medical Center, Duarte, CA
7School of Medicine, Dept of Medical Oncology, Stanford University Medical Center, Stanford, CA
8Community Health Network, Indianapolis, IN
9Weill Cornell Medical College, New York, NY
10Providence Saint Joseph Medical Center/Disney Family Cancer Center, Burbank, CA
11Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
12Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY

Background: Follicular lymphoma (FL) is the most common subtype of indolent NHL. Current chemoimmunotherapeutic regimens used for FL are not curative. Rituximab, as a single-agent and in combination with chemotherapy, is a commonly used approach for frontline therapy of FL. Ibrutinib, a first-in-class, once-daily, oral inhibitor of Bruton’s tyrosine kinase, has shown activity in a phase 1, first-in-human, dose-escalation trial in patients with relapsed/refractory FL, with an overall response rate (ORR) of 38% (6/16) including 3 complete responses [CRs]) (Advani, JCO 2013). In a multicenter, open-label phase 2 trial (PCYC-1125-CA), we evaluated the efficacy and safety of ibrutinib in combination with rituximab in treatment-naïve patients with FL.

Methods: Patients with treatment-naïve, histologically confirmed FL (Grade 1, 2 and 3a, stage II-IV disease) received oral ibrutinib 560 mg once daily until progressive disease (PD) or unacceptable toxicity, combined with rituximab 375 mg/m2 IV once weekly for 4 doses for the first 4 weeks of the study. The primary endpoint was ORR (2007 IWG criteria) as assessed by investigators. Secondary endpoints included duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety.

Results: Among 60 treated patients in study Arm 1, the median age was 58 years (range, 32–84), with 30% of patients aged ≥65 years, and 98% of patients with an Eastern Cooperative Oncology Group performance status of 0-1. At baseline, 80% of patients had Stage III/IV disease, and 10% of patients had grade 3a FL. The mean duration of treatment on ibrutinib was 9.2 months. At a median follow-up of 10.2 months (range, 1.2–16.2), the investigator-assessed ORR was 82% (95% CI: 70.1–89.4), with a CR rate of 27% and PR rate of 55% in all treated patients (Figure). The median time to best response was 2.7 months (range, 1.1–8.3). Median PFS, OS, and DOR are not reached as a result of a small number of PD (n=5) and death (n=1) events. Any-grade adverse events (AEs; ≥20%) included fatigue (63%), diarrhea (50%), nausea (42%), constipation (28%), headache (27%), maculopapular rash (27%), myalgia (23%), vomiting (23%), cough (22%), infusion-related reaction (22%), and dry eye (20%). Grade ≥3 AEs occurred in 43% of patients, and those occurring in >1 patient included fatigue and maculopapular rash (5% each), and neutropenia and hypertension (3% each). There was 1 death several months after study discontinuation due to Hodgkin’s lymphoma. Serious AEs (SAEs) occurred in 13% of patients (12% grade 3 or 4). Any-grade bleeding was reported in 22% of patients, with only 1 grade 2 bleeding event (petechiae); all other events were grade 1. Atrial fibrillation ≥grade 3 occurred in 1 patient. Secondary malignancies were reported in 4 patients: Hodgkin’s lymphoma (n=1; grade 3 and 5); fallopian tube cancer (n=1; grade 3); melanocytic nevus (n=1; grade 1); and basal cell carcinoma (n=1; grade 2). Overall, 28% of patients discontinued ibrutinib in the trial (AEs: 12%; PD: 8%; patient decision: 5%; and investigator decision: 3%). At the time of analysis, 72% of patients continued treatment. Overall, the study treatment was well tolerated.   

Conclusions: In treatment-naïve patients with FL, ibrutinib combined with 4 cycles of rituximab demonstrates robust clinical activity with a high overall response rate. The combination is well tolerated; AEs were primarily grade 1-2 and as expected based on experience with single-agent ibrutinib and previously tested ibrutinib combinations.

Figure. Best Overall Response Rates in All Treated Patients (N=60) and Maximum Percentage Improvement from Baseline SPD (N=60)

Description: C:\Users\BIOI CONNECTIONS\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\CGO7Q27R\ASH 1125 FL figure redraw Color (7).jpg

 

Disclosures: Off Label Use: Ibrutinib for follicular lymphoma. Nastoupil: AbbVie: Research Funding ; TG Therapeutics: Research Funding ; Celgene: Honoraria ; Genentech: Honoraria ; Janssen: Research Funding . Knapp: Celgene: Research Funding ; Heron Pharmaceuticals: Other: Travel expenses , Research Funding ; Merck: Research Funding ; Seattle Genetics, Inc.: Research Funding ; Takeda Pharmaceuticals International Co.: Research Funding ; Brystol-Myers Squibb: Research Funding ; Genentech: Honoraria , Other: Travel expenses , Research Funding ; Pharmacyclics LLC, an AbbVie Company: Research Funding ; EMD Serono: Research Funding . Flinn: Cephalon, Inc; Teva Pharmaceutical Industries Ltd; Genentech, inc; Gilead: Research Funding . Chen: Genentech: Consultancy ; Seattle Genetics: Consultancy , Research Funding ; Janssen: Consultancy ; Gilead: Consultancy . Bhatia: CHOP LLC: Employment , Equity Ownership , Membership on an entity’s Board of Directors or advisory committees ; Pfizer: Honoraria . Martin: Genentech, Inc.: Consultancy , Honoraria , Other: TRAVEL, ACCOMODATIONS, EXPENSES , Speakers Bureau ; Janssen: Honoraria , Other: TRAVEL, ACCOMODATIONS, EXPENSES ; Celgene: Consultancy , Honoraria , Other: TRAVEL, ACCOMODATIONS, EXPENSES ; Gilead: Consultancy . Suzuki: Pharmacyclics LLC, an AbbVie Company: Employment ; AbbVie: Equity Ownership . Beaupre: Pharmacyclics LLC, an AbbVie Company: Employment ; AbbVie: Equity Ownership . Neuenburg: Pharmacyclics LLC, an AbbVie Company: Employment ; AbbVie: Equity Ownership .

*signifies non-member of ASH