Program: Oral and Poster Abstracts
Type: Oral
Session: 624. Lymphoma: Therapy with Biologic Agents, excluding Pre-Clinical Models: Biologic Agents in B Cell Lymphoma
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)
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 .
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