Shorter Treatment with Venclexta May Save Costs for Some With CLL

Time-limited treatment could be the new wave of research in the treatment of chronic lymphocytic leukemia (CLL), according to Nicole Lamanna, M.D.

In an interview with CURE’s sister publication, OncLive, she highlighted data from the randomized phase 3 MURANO trial, designed to evaluate the combination of Venclexta (venetoclax) and Rituxan (rituximab) compared with bendamustine plus rituximab (BR) in patients with CLL. Further, she delved into the need for more studies to test the feasibility of time-limited treatment for these patients.

“Time-limited treatment may save on cost in a big way, and there may be a subset of patients with CLL where this is very doable,” said Lamanna, who is an associate professor of medicine in the Hematologic Malignancies Section in the Division of Hematology/Oncology at NewYork-Presbyterian/Columbia University Medical Center.

Overall, 389 patients received either Venclexta and Rituxan (194 patients) or BR (195 patients). Initial analysis of the study showed a sustained benefit and superior progression-free survival — or the time from treatment to disease progression or worsening – and overall survival with the Venclexta combination compared with BR: the estimated three-year progression-free survival rates were 71.4 percent and 15.2 percent, respectively.

However, another follow-up analysis looked at patients who stopped venetoclax at two years and tested for minimal residual disease (MRD), which showed a very significant correlation between virtually undetectable MRD and prolonged progression-free survival, according to Lamanna.

“One question that arises from these data is whether two years of (Venclexta) is enough—especially for patients who still have a lot of disease at the time,” she said. “There were more relapses in that subgroup. The (progression-free survival) still looks great, but there is no question that patients with high levels of detectable disease will relapse quicker. We need longer follow-up on these data to see how these (progression-free survival) curves hold up, and to see whether there are subsets of patients who break out and would benefit from longer duration of therapy. However, this is a very good study showing that you can do fixed durations of a drug like (Venclexta).”

Lamanna noted that at the 2018 American Society of Hematology annual meeting, a variety of research was looking at different combination to treat CLL. “Ultimately, everyone wants to know what the time to next treatment is for the patients who do well on a fixed duration of treatment. Could you then reintroduce the drug later on or will patients develop resistance? These are all very important questions,” she said.

However, cost may also come in to play once all is said and done. “One major issue you have to keep in mind is cost; these regimens are very expensive,” Lamanna said. When patients are started on them, they are started indefinitely unless they progress or have a severe adverse reaction. Newer therapies are getting approved all the time, and most of us want to continue focusing on fixed duration.”

This article was curated from an article that original appeared on OncLive, as “CLL Research Explores Feasibility of Time-Limited Treatment.”