On March 12, 2020 Roche (SIX: RO, ROG; OTCQX: RHHBY) reported that the European Commission has approved Venclyxto (venetoclax) in combination with Gazyvaro (obinutuzumab) for the treatment of adult patients with previously untreated chronic lymphocytic leukaemia (CLL) (Press release, Hoffmann-La Roche, MAR 12, 2020, View Source [SID1234555456]).
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"Venclyxto plus Gazyvaro is the first fixed-duration, chemotherapy-free treatment option that has been shown to help patients with untreated chronic lymphocytic leukaemia live longer without their disease progressing," said Levi Garraway, M.D., Ph.D., Roche’s Chief Medical Officer and Head of Global Product Development. "This is an important step forward for adults with this disease in the EU, who will now have an effective treatment option that enables them to end treatment after one year."
The approval is based on results from the primary analysis of the pivotal phase III CLL14 study, which evaluated the combination of 12-month, fixed-duration Venclyxto plus Gazyvaro compared to Gazyvaro plus chlorambucil in adults with previously untreated CLL who had co-existing medical conditions. Results from the primary analysis showed that the combination of Venclyxto plus Gazyvaro led to a 65% reduction in the risk of disease worsening or death (progression-free survival [PFS], as assessed by investigators) compared to Gazyvaro plus chlorambucil, a current standard-of-care for CLL (HR=0.35; 95% CI 0.23-0.53; p<0.0001). When PFS was assessed by an independent review committee, this finding was confirmed. Venclyxto plus Gazyvaro also showed higher response rates (ORR), doubled the complete response rates (CR/CRi) and demonstrated higher rates of minimal residual disease (MRD)-negativity, meaning that no cancer can be detected using a specific and highly sensitive test. In peripheral blood, MRD-negativity rates were 76% for Venclyxto plus Gazyvaro versus 35% for Gazyvaro plus chlorambucil, and in bone marrow MRD-negativity rates were 57% versus 17%, respectively. Results from an updated efficacy analysis (with a median follow-up of 40 months) were consistent with the primary data, and showed that the combination reduced the risk of disease worsening or death by 69% compared to Gazyvaro plus chlorambucil (HR=0.31; 95% CI 0.22-0.44). Safety for Venclyxto plus Gazyvaro appeared consistent with the known safety profile of the individual medicines, and no new safety signals were identified with the combination. The most commonly reported adverse events in people treated with Venclyxto plus Gazyvaro were low white blood cell count (neutropenia), diarrhoea and upper respiratory tract infection.
Results from the CLL14 study further demonstrate Venclyxto’s potential across multiple lines (in the R/R and the frontline settings) in CLL. Previously, the European Commission has approved Venclyxto in combination with MabThera (rituximab) for the treatment of adults with CLL who have received at least one prior therapy, and as a monotherapy for the treatment of CLL in the presence or absence of 17p deletion or TP53 mutation in adult patients who are unsuitable for or have failed a B-cell receptor pathway inhibitor. The US Food and Drug Administration (FDA) approved Venclexta in combination with Gazyva for the treatment of people with previously untreated CLL with co-existing medical conditions in May 2019. This followed rapid review and approval of the supplemental New Drug Application under the FDA’s Real-Time Oncology Review (RTOR) and Assessment Aid pilot programmes. Additional submissions of the data to health authorities around the world are still ongoing, with the goal of bringing this new treatment option to more patients as soon as possible.
Venclexta/Venclyxto is being developed by AbbVie and Roche. It is jointly commercialised by AbbVie and Genentech, a member of the Roche Group, in the US, under the brand name Venclexta, and commercialised by AbbVie outside of the US.
About the CLL14 study1
CLL14 (NCT02242942) is a randomised phase III study evaluating the combination of fixed-duration Venclyxto plus Gazyvaro compared to Gazyvaro plus chlorambucil in adult patients with previously untreated chronic lymphocytic leukaemia (CLL) and co-existing medical conditions. 432 patients with previously untreated CLL were randomly assigned to receive either a 12-month duration of Venclyxto alongside six-month duration of Gazyvaro (Arm A) or six-month duration of Gazyvaro alongside 12-month duration of chlorambucil (Arm B). Arm A started with an initial dosing of Gazyvaro followed by a five-week Venclyxto dose ramp-up to help reduce the risk of tumour lysis syndrome. The primary endpoint of the study is investigator-assessed (INV) progression-free survival (PFS). Secondary endpoints include PFS assessed by independent review committee (IRC), minimal residual disease (MRD) status, overall response rate (ORR), complete response rate (CR, with or without complete blood count recovery), overall survival, duration of response, event-free survival, time to next CLL treatment, and safety. MRD-negativity means no cancer can be detected using a specific, highly sensitive test, and was defined as less than one cancer cell in 10,000 leukocytes. The CLL14 study is being conducted in cooperation with the German CLL Study Group, headed by Michael Hallek, MD, University of Cologne.
CLL14 study primary analysis results2
Treatment arm Venclyxto + Gazyvaro
(n=216) Gazyvaro + chlorambucil
(n=216)
INV-assessed PFS (primary endpoint)
Median PFS Not reached Not reached
Hazard ratio 0.35 (95% CI 0.23-0.53), p<0.0001
Additional efficacy results (secondary endpoints)
IRC-assessed PFSa
Median PFS Not reached Not reached
Hazard ratio 0.33 (95% CI 0.22-0.51), p<0.0001
Response rates
ORR 85% 71%
CR + complete remission with incomplete bone marrow recovery (CRi) 50% 23%
MRDb
MRD-negative, bone marrow, 57% 17%
p-value p<0.0001
MRD-negative, peripheral blood, 76% 35%
p-value p<0.0001
Safety
Adverse events The most common adverse reactions (≥20%) with Venclyxto plus Gazyvaro were low white blood cell count (neutropenia), diarrhoea and upper respiratory tract infection. The most common serious adverse events in people treated with Venclyxto plus Gazyvaro were febrile neutropenia, pneumonia, infusion-related infection and pyrexia.
a Data at median follow-up of 28 months
b Data at three months following end of combination treatment, in the intention-to-treat population
About Venclyxto (venetoclax)
Venclyxto is a first-in-class targeted medicine designed to selectively bind and inhibit the B-cell lymphoma-2 (BCL-2) protein. In some blood cancers and other tumours, BCL-2 builds up and prevents cancer cells from dying or self-destructing, a process called apoptosis. Venclyxto blocks the BCL-2 protein and works to restore the process of apoptosis.
Venclexta/Venclyxto is being developed by AbbVie and Roche. It is jointly commercialised by AbbVie and Genentech, a member of the Roche Group, in the US, under the brand name Venclexta, and commercialised by AbbVie outside of the US. Together, the companies are committed to research with Venclexta/Venclyxto, which is currently being studied in clinical trials across several types of blood and other cancers.
In the US, Venclexta has been granted five Breakthrough Therapy Designations by the US Food and Drug Administration: one for previously untreated chronic lymphocytic leukaemia (CLL), two for relapsed or refractory CLL and two for previously untreated acute myeloid leukaemia.
About Gazyvaro (obinutuzumab)
Gazyvaro is an engineered monoclonal antibody designed to attach to CD20, a protein expressed on certain B-cells, but not on stem cells or plasma cells. Gazyvaro is designed to attack and destroy targeted B-cells both directly and together with the body’s immune system. Gazyvaro is marketed as Gazyva in the US.
Gazyva/Gazyvaro is currently approved in more than 90 countries in combination with chlorambucil for people with previously untreated chronic lymphocytic leukaemia, in more than 80 countries in combination with bendamustine for people with certain types of previously treated follicular lymphoma and in more than 70 countries in combination with chemotherapy for previously untreated follicular lymphoma.
Additional combination studies investigating Gazyvaro with other approved or investigational medicines, including cancer immunotherapies and small molecule inhibitors, are underway across a range of blood cancers.
About chronic lymphocytic leukaemia
Chronic lymphocytic leukaemia (CLL) is the most common type of leukaemia in the Western world.3 CLL mainly affects men and the median age at diagnosis is about 70 years.4 Worldwide, the incidence of all leukaemias is estimated to be over 400,000, with an incidence of over 100,000 in Europe.5 CLL is estimated to affect around one-third of all people newly diagnosed with leukaemia.3
About Roche in haematology
Roche has been developing medicines for people with malignant and non-malignant blood diseases for over 20 years; our experience and knowledge in this therapeutic area runs deep. Today, we are investing more than ever in our effort to bring innovative treatment options to patients across a wide range of haematologic diseases. Our approved medicines include MabThera/Rituxan (rituximab), Gazyva/Gazyvaro (obinutuzumab), Polivy (polatuzumab vedotin), Venclexta/Venclyxto (venetoclax) in collaboration with AbbVie, and Hemlibra (emicizumab). Our pipeline of investigational haematology medicines includes idasanutlin, a small molecule which inhibits the interaction of MDM2 with p53; T-cell engaging bispecific antibodies targeting both CD20 and CD3, Tecentriq (atezolizumab), a monoclonal antibody designed to bind with PD-L1; and crovalimab, an anti-C5 antibody engineered to optimise complement inhibition. Our scientific expertise, combined with the breadth of our portfolio and pipeline, also provides a unique opportunity to develop combination regimens that aim to improve the lives of patients even further.