THURSDAY, June 20, 2024 (HealthDay News) — For patients with specific subtypes of relapsed or refractory diffuse large B-cell lymphoma (DLBCL), treatment with venetoclax, ibrutinib, prednisone, obinutuzumab, and lenalidomide (ViPOR) yields durable remission, according to a study published in the June 20 issue of the New England Journal of Medicine.
Christopher Melani, M.D., from the National Cancer Institute in Bethesda, Maryland, and colleagues performed a single-center, phase 1b to 2 study of a regimen of ViPOR in relapsed or refractory DLBCL. Twenty patients were included in phase 1b, 10 with DLBCL, which assessed four dose levels of venetoclax. A phase 2 expansion was conducted in 40 patients with germinal-center B-cell (GCB) and non-GCB DLBCL.
The researchers established venetoclax at a dose of 800 mg as the recommended phase 2 dose. All patients in phase 2 had toxic effects, including grade 3 or 4 neutropenia, thrombocytopenia, anemia, and febrile neutropenia (in 24, 23, 7 and 1 percent of the cycles, respectively). Overall, 54 percent of the evaluable patients with DLBCL had objective responses; complete responses occurred in 38 percent, which were exclusively in patients with non-GCB DLBCL and high-grade B-cell lymphoma with rearrangements of MYC and BCL2 or BCL6 (or both). At the end of ViPOR therapy, circulating tumor DNA was undetectable in 33 percent of the patients. Two-year progression-free and overall survival were 34 and 36 percent, respectively, with a median follow-up of 40 months.
“Although the efficacy of ViPOR in specific molecular subtypes limited the subgroup of patients with DLBCL who had potentially curable disease, this very specificity provides some confidence in the generalizability of our results,” the authors write.
Genentech provided venetoclax and obinutuzumab and Bristol Myers Squibb-Celgene provided lenalidomide for the study.
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