Effect of dose modifications on response to duvelisib in patients with relapsed/refractory CLL/SLL in the duo trial

P. Ghia, I. W. Flinn, N. Lamanna, M. Montillo, Á. Illés, G. Etienne, J. Delgado, B. J. Kuss, C. S. Tam, F. Offner, F. Bosch, M. S. Davids, U. Jager, F. Cymbalista, D. T. Weaver, S. Lustgarten, H. Youssoufian, S. Stilgenbauer

    Research output: Contribution to journalMeeting Abstractpeer-review

    Abstract

    Introduction: Duvelisib (DUV), a first-in-class oral dual PI3K-δ,γ inhibitor, is approved for treatment of relapsed/refractory (R/R) CLL/SLL after ≥ 2 prior therapies. In the phase 3 DUO trial, DUV 25 mg BID significantly improved efficacy vs ofatumumab (OFA; mPFS, 13.3 vs 9.9 mo; HR, 0.52 [P < .0001]; ORR, 74% vs 45% [P < .0001]) in pts with R/R CLL/SLL (Flinn et al. Blood 2018). Treatment-emergent AEs (TEAEs) of special interest (AESIs) such as infections, diarrhea, colitis, neutropenia, rash, ALT/AST elevation, and pneumonitis, were moderate and manageable with early intervention and dose modification. We examined dose-modification patterns and their impact on response to DUV in the DUO trial.

    Methods: TEAEs were assessed according to the NCI CTCAE v4.03. Dose interruptions (DI) or reductions (DR) to 15, 10, or 5 mg BID were permitted per study protocol to manage TEAEs. Responses were assessed by an independent review committee before and after dose modifications and were analyzed using descriptive statistics.

    Results: Among 158 DUV-treated pts, median duration of DUV exposure was 11.6 mo (vs 5.3 mo, OFA). DI and DR occurred in 80% (126/158) and 27% (43/158) of pts, respectively. The most common cause of DI was diarrhea (23%), followed by neutropenia (12%) and pneumonia or colitis (11% each). Among responders (n = 118), median time to first response on DUV was 1.9 mo and estimated median duration of response was 11.1 mo. Median time to first DI was 3.9 mo and median duration of DI was 15 d (range, 1-133 d). Response to DUV was improved or maintained in most pts evaluated for response who had ≥ 1 DI for > 1 wk (84% [42/50]) or > 2 wk (82% [31/38]) followed by ≥ 3 wk on DUV. In a landmark analysis, median PFS was similar in pts with DI and those without DI for > 1 wk (17.8 vs 16.3 mo) or > 2 wk (17.8 vs 16.3 mo) within the first 3 mo. The median time to DR after CR/PR was 5.6 mo (n = 25) and median duration was 3.4 mo. Median time to onset across AESIs after starting DUV ranged from 2.2 to 4.3 mo; median time to resolution was within 4 wk across AESIs. Proportions of pts experiencing AESIs were stable or decreased over time after 3-6 mo: 0-3 mo, 64% (101/158); > 3-6 mo, 63% (86/137); > 6-9 mo, 47% (54/114); > 9-12 mo, 52% (52/100), and seldom led to discontinuation of DUV (≤ 10%).

    Conclusions: DI/DR can contribute to the effective management of TEAEs with DUV. These findings suggest that DI of > 1-2 weeks or more do not appear to significantly impact response to DUV or PFS.
    Original languageEnglish
    Article number166
    Pages (from-to)214-216
    Number of pages3
    JournalHematological Oncology
    Volume37
    Issue numberS2
    DOIs
    Publication statusPublished - Jun 2019
    Event15th International Conference on Malignant Lymphoma - Palazzo dei Congressi, Lugano, Switzerland
    Duration: 18 Jun 201922 Jun 2019
    https://www.icml.ch/icml/home.html (Organisation's website, with links to past conferences)

    Keywords

    • chronic lymphocytic leukemia (CLL)
    • P13K/AKT/mTOR
    • small lymphocytic lymphoma (SLL)

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