Venetoclax–obinutuzumab combinations are effective in fit patients with CLL

Patients with chronic lymphocytic leukaemia (CLL) typically receive first-line chemoimmunotherapy comprising the anti-CD20 antibody rituximab plus either fludarabine and cyclophosphamide or bendamustine for patients ≤65 or >65 years of age, respectively. In the past decade, several agents have been approved for this malignancy, including the BTK inhibitor ibrutinib, the BCL2 antagonist venetoclax and the novel anti-CD20 antibody obinutuzumab; however, data from multi-arm comparative trials of these agents are limited. Now, results from the phase III GAIA–CLL13 trial support the use of venetoclax–obinutuzumab with or without ibrutinib in this setting.

This trial involved patients with previously untreated advanced-stage CLL of whom 64% were ≤65 years of age and 72% had an ECOG performance status score of 0. Patients were allocated standard chemoimmunotherapy (n = 229) or venetoclax in combination with either rituximab (n = 237), obinutuzumab (n = 229) or obinutuzumab–ibrutinib (triple combination) (n = 231). The primary end points were undetectable minimal residual disease (MRD) in peripheral blood at 15 months and progression-free survival (PFS).