-Author name in bold denotes the presenting author
-Asterisk * with author name denotes a Non-ASH member
Clinically Relevant Abstract denotes an abstract that is clinically relevant.

PhD Trainee denotes that this is a recommended PHD Trainee Session.

Ticketed Session denotes that this is a ticketed session.

3140 Acalabrutinib Vs Idelalisib Plus Rituximab or Bendamustine Plus Rituximab in Relapsed/Refractory Chronic Lymphocytic Leukemia: Ascend Final Results

Program: Oral and Poster Abstracts
Session: 642. CLL: Therapy, excluding Transplantation: Poster III
Hematology Disease Topics & Pathways:
Biological, Adult, survivorship, Diseases, Therapies, Combinations, enzyme inhibitors, white blood cells, Cell Lineage, Lymphoid Malignancies, Study Population, Clinically relevant, Quality Improvement , TKI
Monday, December 7, 2020, 7:00 AM-3:30 PM

Paolo Ghia, MD, PhD1, Andrzej Pluta, MD2*, Malgorzata Wach, MD PhD3*, Daniel Lysak4*, Tomas Kozak5*, Martin Šimkovič, MD, PhD6*, Iryna Kryachok, Prof., PhD7*, Árpád Illés, MD, PhD8*, Javier de la Serna9*, Sean Dolan10*, Philip Campbell, MBBS11, Gerardo Musuraca, MD, PhD12*, Abraham Jacob, MD13, Eric J. Avery, MD14, Jae Hoon Lee, MD, PhD15, Denise Wang16*, Priti Patel, MD16 and Wojciech Jurczak17*

1Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
2Department of Hematological Oncology, Oncology Specialist Hospital, Brzozow, Poland
3Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
4Fakultní Nemocnice Plzen, Pilsen, Czech Republic
5Fakultní Nemocnice Královske Vinohrady, Prague, Czech Republic
6University Hospital Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
7National Cancer Institute, Kiev, Ukraine
8Faculty of Medicine, Department of Hematology, University of Debrecen, Debrecen, Hungary
9Hospital Universitario 12 de Octubre, Madrid, Spain
10Saint John Regional Hospital, University of New Brunswick, New Brunswick, Canada
11Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
12Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
13The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
14Nebraska Hematology Oncology, Lincoln, NE
15Gachon University Gil Medical Center, Incheon, Korea, Republic of (South)
16Acerta Pharma, South San Francisco, CA
17Maria Sklodowska-Curie National Institute of Oncology, Krakow, Poland

Background: Acalabrutinib (acala) is a next-generation, highly selective, covalent Bruton tyrosine kinase inhibitor approved for patients with chronic lymphocytic leukemia (CLL) including those with relapsed/refractory (R/R) CLL. The efficacy and safety of acala alone versus idelalisib (Id) plus rituximab (R) (IdR) or bendamustine (B) plus R (BR) were shown in patients with R/R CLL in a preplanned interim analysis of ASCEND; final results are reported herein.

Methods: In this randomized, multicenter, phase 3, open-label study (NCT02970318), patients with R/R CLL were randomized 1:1 to receive oral (PO) acala 100 mg twice daily (BID) or investigator’s (INV) choice of IdR (Id: 150 mg PO BID until progression or toxicity; R: 375 x1 then 500 mg/m2 intravenously [IV] for 8 total infusions) or BR (B: 70 mg/m2 IV and R: 375 x1 then 500 mg/m2 IV for 6 total cycles) until progression or toxicity. Progression-free survival (PFS), overall survival (OS), overall response rate (ORR), and safety were assessed.

Results: 310 patients (acala, n=155; IdR, n=119; BR, n=36) were enrolled (median age: 67 y; del(17p) 16%, del(11q) 27%, Rai stage 3/4 42%). At a median follow-up of 22.0 m, acala significantly prolonged INV-assessed PFS vs IdR/BR (median: not reached vs 16.8 m; hazard ratio: 0.27, P<0.0001); 18-m PFS rates were 82% for acala and 48% for IdR/BR. 18-m OS rate was 88% for both treatment regimens. ORR was 80% with acala vs 84% with IdR/BR (ORR + partial response with lymphocytosis: 92% vs 88%, respectively). Common adverse events (AEs) are listed in the Table. AEs led to drug discontinuation in 16% of acala, 56% of IdR, and 17% of BR patients. AEs of interest included atrial fibrillation (acala 6%, IdR/BR 3%), major hemorrhage (all grade; acala 3%, IdR/BR 3%), grade ≥3 infections (acala 20%, IdR/BR 25%), and second primary malignancies excluding non-melanoma skin cancer (acala 5%, IdR/BR 2%).

Conclusions: Final ASCEND results with additional follow-up confirm earlier findings and support the favorable efficacy and safety of acala compared with standard-of-care regimens in patients with R/R CLL.

© 2020 American Society of Clinical Oncology, Inc. Reused with permission. This abstract was accepted and previously presented at the 2020 ASCO Annual Meeting. All rights reserved.

Disclosures: Ghia: Novartis: Research Funding; ArQule: Consultancy, Honoraria; Acerta/AstraZeneca: Consultancy, Honoraria; Adaptive, Dynamo: Consultancy, Honoraria; Gilead: Consultancy, Honoraria, Research Funding; BeiGene: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding; Celgene/Juno: Consultancy, Honoraria; Lilly: Consultancy, Honoraria; MEI: Consultancy, Honoraria; Sunesis: Consultancy, Honoraria, Research Funding; AbbVie: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding. Pluta: Janssen-Cilag, Kartos Therapeutics, Iqvia, Roche, Acerta Pharma, Pharmacyclics, BeiGene, Takeda: Research Funding; Celgene, Servier, Takeda, Novartis: Honoraria; Celgene: Other: Travel, Accommodations, Expenses. Lysak: Abbvie, Novartis, Roche, Janssen-Cilag: Consultancy. Kozak: Amgen, Novartis, Abbvie, Gilead Sciences: Consultancy; Abbvie, Tak: Other: Travel, Accommodations, Expenses. Šimkovič: Acerta Pharma: Consultancy; Gilead Sciences: Consultancy, Other: Travel, Accommodations, Expenses; Janssen-Cilag: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Speakers Bureau; University Hospital Hradec Kralove: Current Employment; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Speakers Bureau. Kryachok: Takeda, Roche, Abbvie, MSD Oncology: Other: Travel, Accommodations, Expenses; Janssen Oncology, Bayer, Karyopharm Therapeutics, MSD Oncology, Acerta Pharma, Abbvie, Debiopharm Group: Research Funding; Takeda, Janssen Oncology: Consultancy. Illés: Takeda, Seattle Genetics: Research Funding; Novartis, Janssen, Pfizer, Roche;: Other: Travel, Accommodations, Expenses; Celgene, Janssen, Novartis,Roche, Takeda: Consultancy; Janssen, Celgene, Takeda, Novartis Pharma SAS, Pfizer Pharmaceuticals Israel, Roche;: Consultancy, Honoraria. de la Serna: Abbvie, Janssen: Speakers Bureau; Abbvie, AstraZeneca: Other: Travel, Accommodations, Expenses; Gilead, AstraZeneca, Abbvie, Janssen, Sandoz, F. Hoffmann-La Roche: Consultancy; Abbvie, Pharmacyclics, Novartis, Janssen, Acerta, AstraZeneca, BioGene, UCB, Sandoz: Honoraria; F. Hoffmann-La Roche, Abbvie, Pharmacyclics, Gilead, GlaxoSmithKline, Novartis, Janssen, Roche, Acerta, AstraZeneca, BioGene, UCB: Research Funding. Campbell: Amgen, Novartis, Roche, Janssen, Celgene (BMS): Research Funding; AstraZeneca, Janssen, Roche, Amgen, CSL Behring, Novartis: Consultancy. Musuraca: AstraZeneca, Debiopharm Group, Janssen, Gilead Sciences: Consultancy; TG Therapeutics, Acerta Pharma, AstraZeneca, Janssen, Bayer, Debiopharm Group, Epizyme, Merck, MorphoSys, MEI Pharma, Celerion, Roche, Servier, BeiGene: Research Funding. Jacob: AstraZeneca: Consultancy, Honoraria, Research Funding; AstraZeneca, GlaxoSmithKline, Horizon Discovery, Oxford Biomedica, Midlands Haematology Services: Current equity holder in publicly-traded company. Avery: AstraZeneca: Consultancy, Other: Travel, Accommodations, Expenses; Lilly: Research Funding. Wang: Acerta Pharma LLC: Current Employment; Global Blood Therapeutics.: Consultancy. Patel: AstraZeneca: Current Employment, Current equity holder in publicly-traded company. Jurczak: Jagiellonian University: Ended employment in the past 24 months, Research Funding; Janssen, MeiPharma, Merck, Pharmacyclics, Roche, Tekeda, TG Therapeutics: Research Funding; Maria Sklodowska-Curie National Research Institute of Oncology: Consultancy, Current Employment.

*signifies non-member of ASH