AbbVie Seeks FDA Approval for Venetoclax and Acalabrutinib Combination in Untreated CLL
AbbVie submitted a supplemental New Drug Application (sNDA) to the FDA for a fixed-duration, all-oral combination of VENCLEXTA (venetoclax) and acalab...
Breakthrough Clinical Results
AbbVie submitted a supplemental New Drug Application (sNDA) to the FDA for a fixed-duration, all-oral combination of VENCLEXTA (venetoclax) and acalabrutinib for previously untreated chronic lymphocytic leukemia (CLL) patients. This submission follows positive Phase 3 AMPLIFY trial results, demonstrating a statistically significant improvement in progression-free survival compared to standard chemoimmunotherapy. The combination offers the potential for time off treatment, representing a potential advancement in frontline CLL care. The AMPLIFY trial, sponsored by AstraZeneca, evaluated the combination with or without obinutuzumab versus chemoimmunotherapy in patients without del(17p) or TP53 mutation. The most common adverse events were neutropenia, hemorrhage, and COVID-19.
Key Highlights
- AbbVie submitted an sNDA to the FDA for VENCLEXTA (venetoclax) and acalabrutinib combination in untreated CLL.
- Phase 3 AMPLIFY trial showed improved progression-free survival compared to chemoimmunotherapy.
- The regimen is a fixed-duration, all-oral treatment with potential for time off treatment.
- Safety profile is consistent with the known safety profiles of individual therapies.
Incidence and Prevalence
Latest Estimates of Chronic Lymphocytic Leukemia Incidence and Prevalence
Based on the most recent available data from 2024, a retrospective cohort study examined patients with mature B cell malignancies including chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), multiple myeloma, and non-Hodgkin's lymphoma. This study included data extracted from the Humedica database (H-DB) and Guardian Research Network (GRN) database covering the period from October 1, 2015 to March 10, 2020.
In this particular study, researchers identified 2,221 patients with secondary immunodeficiency disease (SID) and 19,141 patients without SID who had these B-cell malignancies. However, the study primarily focused on comparing infection burden rather than providing specific global incidence or prevalence estimates for CLL.
From earlier research in 2013, CLL was described as having clonal evolution as a key feature of cancer progression and relapse, with researchers examining intratumoral heterogeneity in 149 CLL cases.
A 2009 study characterized B-cell chronic lymphocytic leukemia (CLL) by an accumulation in peripheral blood of many long-lived lymphocytes that do not die because of the deregulation of apoptosis. Additionally, research from 2006 noted that B-CLL represents an anomaly since there is not only high numbers of circulating B cells characteristic of the malignancy, but also a massive expansion of both CD4 and CD8 T cells.
It's important to note that specific global epidemiological statistics or incidence rates for Chronic Lymphocytic Leukemia are not available in the current data. The available information focuses primarily on clinical characteristics, treatment approaches, and biological features of CLL rather than comprehensive epidemiological data on a global scale.
Study Design Parameters
Study Design Parameters and Endpoints in Key CLL Trials
Study Designs
- Case-control studies have been utilized, including one with 113 ALL patients, 82 CLL patients, and 146 healthy controls of Russian origin investigating TNR/11q#1 variants
- Multicenter prospective trials have been designed with patients stratified and treated according to prognostic risk
- Recent trials specifically investigate whether early and aggressive treatment intervention improves survival in poor prognosis patients
- Statistical analysis methods include Fisher's exact test for comparing allele and genotype distributions
Diagnostic Parameters
- CLL diagnosis requires at least 5000 B-lymphocytes per microliter in peripheral blood
- Immunophenotyping is essential for establishing diagnosis
- A scoring system using CD200, CD20, CD43 and CD45 expression showed 98.2% sensitivity in analytical cohorts
- Bone marrow studies with immunophenotyping and detection of genetic abnormalities are performed
Prognostic Markers and Risk Stratification
- Clinical staging remains the best prognostic indicator
- Additional prognostic value from cytogenetic status, bone marrow infiltration pattern, and lymphocyte doubling time
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Molecular prognostic factors significantly improve disease subgrouping:
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Immunoglobulin V(H) gene mutation status divides CLL into two prognostic groups
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Unmutated V(H) genes associated with worse prognosis than mutated V(H) genes
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V(H)3-21 gene utilization indicates poor outcome regardless of mutation status
- Important biomarkers include CD38, ZAP-70, IGVH mutational status, mutations in TP53 and NOTCH1, and chromosomal abnormalities
Treatment Endpoints
- Response rates including molecular remissions are key endpoints
- Progression-free survival is critical, with some therapies achieving more than eight years in certain genetic subgroups
- Overall survival is particularly important for aggressive forms like accelerated CLL (a-CLL)
- Minimal residual disease (MRD) evaluation is increasingly used as an endpoint
Treatment Approaches
- Chemoimmunotherapy (chemotherapy with anti-CD20 antibodies) is standard first-line treatment
- In younger patients without comorbidities, fludarabine, cyclophosphamide, and rituximab prolongs survival
- Patients with comorbidities receive chlorambucil and obinutuzumab
- Newer targeted therapies include BTK inhibitors (ibrutinib, acalabrutinib) and Bcl2 inhibitors (venetoclax)
- Second-generation BTKi (acalabrutinib) shows prompt clinical response in a-CLL
Methodological Considerations
- Some studies use bone marrow trephine biopsy specimen immunostaining (BMT/IS) and computerized image analysis (CIMA) to quantify residual disease
- Comparison of methodologies for detecting minimal residual disease includes cytologic, flow cytometric, cytogenetic, and molecular analysis
Drug used in other indications
Indications and Intervention Models for VENCLEXTA and Acalabrutinib Trials
Based on the available information, there is insufficient data to provide details about other indications beyond Chronic Lymphocytic Leukemia (CLL) for which VENCLEXTA (venetoclax) and acalabrutinib are being trialed. Similarly, no specific information is available regarding the intervention models being used in these clinical trials.
The combination therapy of VENCLEXTA and acalabrutinib is known to be used in treating CLL, but current trial information for additional indications and their corresponding study designs is not documented in the available resources.
For patients and healthcare professionals interested in the latest clinical trial information for these medications, consulting official clinical trial registries such as ClinicalTrials.gov or reaching out to the manufacturers (AbbVie/Genentech for VENCLEXTA and AstraZeneca for acalabrutinib) would provide the most current and comprehensive information about ongoing trials and their specific protocols.
