Bita Fakhri, MD, MPH, a professor of medicine in the Division of Hematology/Oncology at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses the trials that led to ibrutinib (Imbruvica)-containing regimens becoming the standard of care for chronic lymphocytic leukemia (CLL) over traditional chemotherapy options.

The 2018 ASH Annual Meeting brought 2 major trials that compared chemotherapy to ibrutinib-containing regimens in CLL, explains Fakhri. One phase III trial examined bendamustine plus rituximab (Rituxan), versus ibrutinib alone, versus ibrutinib plus rituximab in older patients with CLL. Both ibrutinib-containing arms had more positive results compared with the chemotherapy arm and met the primary endpoint of progression-free survival (PFS). Based on these data, ibrutinib alone or in combination with rituximab became the standard of care for older patients with previously untreated CLL, says Fakhri.

At the same time, the phase III ECOG-E1912 trial compared the chemoimmunotherapy regimen of intravenous fludarabine, cyclophosphamide, and rituximab versus ibrutinib plus rituximab. The PFS for the ibrutinib arm was superior to the chemotherapy arm and led to ibrutinib plus rituximab becoming the standard of care for treatment-naïve younger patients with CLL, concludes Fakhri.