Comparison of acalabrutinib plus obinutuzumab, ibrutinib plus obinutuzumab and venetoclax plus obinutuzumab for untreated CLL: a network meta-analysis

The optimal chemotherapy-free regimens for treatment-naive CLL still remains undefined. We searched relevant published reports. Three trials with 1017 subjects were identified. In the network meta-analysis, acalabrutinib plus obinutuzumab (Aca + Obi) improved PFS than ibrutinib plus obinutuzumab (Ib...

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Published in:Leukemia & lymphoma Vol. 61; no. 14; pp. 3432 - 3439
Main Authors: Sheng, Zhixin, Song, Shilei, Yu, Miao, Zhu, Hongguang, Gao, Anran, Gao, Weijie, Ran, Xuehong, Huo, Da
Format: Journal Article
Language:English
Published: United States Taylor & Francis 05.12.2020
Subjects:
Acalabrutinib
Adenine - analogs & derivatives
Antibodies, Monoclonal, Humanized
Antineoplastic Combined Chemotherapy Protocols - adverse effects
Benzamides
Bridged Bicyclo Compounds, Heterocyclic
Chlorambucil - therapeutic use
chronic lymphocytic leukemia
Humans
ibrutinib
Leukemia, Lymphocytic, Chronic, B-Cell - drug therapy
meta-analysis
obinutuzumab
Piperidines
Prospective Studies
Pyrazines
Sulfonamides
venetoclax
ibrutinib
meta-analysis
chronic lymphocytic leukemia
Acalabrutinib
venetoclax
obinutuzumab
ISSN:1042-8194, 1029-2403, 1029-2403
Online Access:Get full text
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Summary:The optimal chemotherapy-free regimens for treatment-naive CLL still remains undefined. We searched relevant published reports. Three trials with 1017 subjects were identified. In the network meta-analysis, acalabrutinib plus obinutuzumab (Aca + Obi) improved PFS than ibrutinib plus obinutuzumab (Ibu + Obi) (HR:0.43, p = .02) and venetoclax plus obinutuzumab (Ven + Obi) (HR:0.30, p < .001) as IRC assessment. Sensitivity analysis of investigator assessment also showed improved PFS with Aca + Obi than Ibu + Obi (HR:0.46, p = .04) and Ven + Obi (HR:0.34, p = .002). Among these first-line treatments (Aca + Obi, Ibu + Obi, Ven + Obi and chlorambucil plus obinutuzumab (Chl + Obi)), Aca + Obi regimen had the highest probability of 99.1% (IRC assessment) or 98.0% (investigator assessment) to reach the longest PFS. The survival advantage with Aca + Obi was not statistically significant, compared to Ibu + Obi (HR:0.51, p = .21) and Ven + Obi (HR:0.38, p = .07). No significant difference was found in AEs analysis. Our data indicated that Aca + Obi seemed to prolong the PFS than Ibu + Obi and Ven + Obi. Considering our limits, prospective clinical trials directly comparing these regimens are warranted.
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ISSN:1042-8194
1029-2403
1029-2403
DOI:10.1080/10428194.2020.1811271