Haematologica (Oct 2020)

Zanubrutinib monotherapy for patients with treatment-naïve chronic lymphocytic leukemia and 17p deletion

  • Constantine S. Tam,
  • Tadeusz Robak,
  • Paolo Ghia,
  • Brad S. Kahl,
  • Patricia Walker,
  • Wojciech Janowski,
  • David Simpson,
  • Mazyar Shadman,
  • Peter S. Ganly,
  • Luca Laurenti,
  • Stephen Opat,
  • Monica Tani,
  • Hanna Ciepluch,
  • Emma Verner,
  • Martin Šimkovič,
  • Anders Österborg,
  • Marek Trněný,
  • Alessandra Tedeschi,
  • Jason C. Paik,
  • Sowmya B. Kuwahara,
  • Shibao Feng,
  • Vanitha Ramakrishnan,
  • Aileen Cohen,
  • Jane Huang,
  • Peter Hillmen,
  • Jennifer R. Brown

DOI
https://doi.org/10.3324/haematol.2020.259432
Journal volume & issue
Vol. 106, no. 9

Abstract

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Patients with chronic lymphocytic leukemia or small lymphocytic lymphoma whose tumors carry deletion of chromosome 17p13.1 [del(17p)] have an unfavorable prognosis and respond poorly to standard chemoimmunotherapy. Zanubrutinib is a selective next-generation Bruton tyrosine kinase inhibitor. We evaluated the safety and efficacy of zanubrutinib 160 mg twice daily in treatment-naïve patients with del(17p) disease enrolled in a dedicated, nonrandomized cohort (Arm C) of the phase 3 SEQUOIA trial. A total of 109 patients (median age, 70 years; range, 42 – 86) with centrally confirmed del(17p) were enrolled and treated. After a median of 18.2 months (range, 5.0 – 26.3), seven patients had discontinued study treatment due to progressive disease, four due to an adverse event, and one due to withdrawal of consent. The overall response rate was 94.5% with 3.7% of patients achieving complete response with or without incomplete hematologic recovery. The estimated 18-month progression-free survival rate was 88.6% (95% CI, 79.0 – 94.0) and the estimated 18-month overall survival rate was 95.1% (95% CI, 88.4 – 98.0). Most common all-grade adverse events included contusion (20.2%), upper respiratory tract infection (19.3%), neutropenia/neutrophil count decreased (17.4%), and diarrhea (16.5%). Grade ≥ 3 adverse events were reported in 53 patients (48.6%), most commonly neutropenia (12.9%) and pneumonia (3.7%). An adverse event of atrial fibrillation was reported in three patients (2.8%). Zanubrutinib was active and well tolerated in this large, prospectively enrolled treatment cohort of previously untreated patients with del(17p) chronic lymphocytic leukemia/small lymphocytic lymphoma. This trial was registered at ClinicalTrials.gov as #NCT03336333.