A Randomized Phase II Study Comparing Consolidation with a Single Dose of 90 Y Ibritumomab Tiuxetan (Zevalin ® ) (Z) vs Maintenance with Rituximab (R)

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Presentation transcript:

A Randomized Phase II Study Comparing Consolidation with a Single Dose of 90 Y Ibritumomab Tiuxetan (Zevalin ® ) (Z) vs Maintenance with Rituximab (R) for Two Years in Patients with Newly Diagnosed Follicular Lymphoma (FL) Responding To R-CHOP. Preliminary Results at 36 Months from Randomization López-Guillermo A et al. Proc ASH 2013;Abstract 369.

Background Patients with follicular lymphoma (FL) can survive for a long time, but disease progression typically occurs 3 to 5 years after treatment. Consolidation with 90 Y-ibritumomab tiuxetan after initial therapy, mainly in the prerituximab era, significantly improved progression-free survival (PFS) and time to next treatment (TTNT) (J Clin Oncol 2013;31:1977). Rituximab maintenance has also demonstrated a substantial benefit in terms of PFS and TTNT in patients who initially received immunochemotherapy (Lancet 2011;377:42). –This approach can be considered a standard for patients with FL. Study objective: To compare 90 Y-ibritumomab tiuxetan consolidation to rituximab maintenance for patients with FL responding to the R-CHOP regimen. López-Guillermo A et al. Proc ASH 2013;Abstract 369.

Rituximab maintenance 1 dose every 8 weeks for 24 months (n = 62) 90 Y-ibritumomab tiuxetan 1 dose (n = 64) Primary endpoint: PFS Secondary endpoints: Complete response rate at end of maintenance period, event-free survival, time to re-treatment, overall survival (OS), safety and toxicity profile, quality of life Phase II ZAR2007 Trial Design López-Guillermo A et al. Proc ASH 2013;Abstract 369. PDs/SDs off study CR/PR Registration InductionConsolidation/maintenance Follow-up 5 years * Stratification by response (CR/PR) R* R-CHOP x 6 Untreated FL Stages II–IV CR = complete response PR = partial response PD = progressive disease SD = stable disease

ZAR2007 Trial Design (continued) CONSOLIDATION: 90 Y-ibritumomab tiuxetan –0.4 mCi/kg IV (total dose capped at 32 mCi) –Rituximab 250 mg/m 2 days -8 and 0 –Between 60 and 90 days after last dose of rituximab (induction period) MAINTENANCE: Rituximab –375 mg/m 2 administered by IV infusion every 8 weeks x 12 doses (24 months) –Starting 60 to 90 days after last dose of rituximab (induction period) –No dose adjustment López-Guillermo A et al. Proc ASH 2013;Abstract 369.

Patient Disposition López-Guillermo A et al. Proc ASH 2013;Abstract Y-ibritumomab tiuxetan (n = 64) Rituximab (n = 62) Not randomly assigned (n = 20): - Incomplete induction treatment or response <PR (n = 8) - Low platelet or neutrophil counts (n = 5) - Bone marrow infiltration >25% (n = 1) - Patient decision (n = 2) - Other (n = 4) Patients registered n = 146 R-CHOP x 6 Patients randomly assigned n = 126 (PR 57; CR 69)

PFS With permission from López-Guillermo A et al. Proc ASH 2013;Abstract 369. Rituximab (n = 62; failed 14) 90 Y-Ibritumomab tiuxetan (n = 64; failed 25) HR = p = Probability of PFS Years from randomization 01 77% 63%

OS Causes of death: Progression (n = 6), graft-versus-host disease (n = 1) With permission from López-Guillermo A et al. Proc ASH 2013;Abstract Y-Ibritumomab tiuxetan Rituximab Probability of OS Years from randomization

Author Conclusions In patients with FL requiring therapy and responding to R-CHOP, rituximab maintenance was superior to consolidation with 90 Y-ibritumomab tiuxetan in terms of PFS. –3-year PFS: 77% vs 63% (HR = 0.517, p = 0.044) However, no significant differences were observed regarding the TTNT (data not shown) or OS. The safety profile was reasonable, with no unexpected toxicities observed in either arm (data not shown). López-Guillermo A et al. Proc ASH 2013;Abstract 369.

Investigator Commentary: ZAR2007 — Preliminary Results of a Phase II Trial Comparing Consolidation with a Single Dose of 90 Y-Ibritumomab Tiuxetan to Rituximab Maintenance for 2 Years in Patients with Newly Diagnosed FL Responding to R-CHOP This randomized Phase II trial evaluated either 2 years of rituximab maintenance or 1 dose of consolidation 90 Y-ibritumomab tiuxetan for patients with FL responding to R-CHOP. I was a little surprised by the results. I thought any differences would be insignificant at the end of the day. But the PFS analysis, at least, favored the rituximab arm. These data are not yet mature, and we need to follow the results as they emerge. I’m not sure these data will change practice per se. I believe the standard is still 2 years of rituximab maintenance, but I might consider administering 90 Y-ibritumomab tiuxetan consolidation in certain situations, eg, for a patient who is planning to be out of town for a significant period — on an 18-month cruise or a year-long trip to Alaska, et cetera. In these circumstances, consolidation with a single dose of 90 Y-ibritumomab tiuxetan may be of benefit for as long as 2 years. Interview with Andrew M Evens, DO, MSc, February 12, 2014