The phase 3 DUO trial: duvelisib vs ofatumumab in relapsed and refractory CLL/SLL.

Abstract

Duvelisib (also known as IPI-145) is an oral, dual inhibitor of phosphatidylinositol 3-kinase δ and γ (PI3K-δ,γ) being developed for treatment of hematologic malignancies. PI3K-δ,γ signaling can promote B-cell proliferation and survival in clonal B-cell malignancies, such as chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). In a phase 1 study, duvelisib showed clinically meaningful activity and acceptable safety in CLL/SLL patients. We report here the results of DUO, a global phase 3 randomized study of duvelisib vs ofatumumab monotherapy for patients with relapsed or refractory (RR) CLL/SLL. Patients were randomized 1:1 to oral duvelisib 25 mg twice daily (n = 160) or ofatumumab IV (n = 159). The study met the primary study end point by significantly improving progression-free survival per independent review committee assessment compared with ofatumumab for all patients (median, 13.3 months vs 9.9 months; hazard ratio [HR] = 0.52; P < .0001), including those with high-risk chromosome 17p13.1 deletions [del(17p)] and/or TP53 mutations (HR = 0.40; P = .0002). The overall response rate was significantly higher with duvelisib (74% vs 45%; P < .0001) regardless of del(17p) status. The most common adverse events were diarrhea, neutropenia, pyrexia, nausea, anemia, and cough on the duvelisib arm, and neutropenia and infusion reactions on the ofatumumab arm. The DUO trial data support duvelisib as a potentially effective treatment option for patients with RR CLL/SLL. This trial was registered at www.clinicaltrials.gov as #NCT02004522.

• Authors: Ian W Flinn, Peter Hillmen, Marco Montillo, Zsolt Nagy, Árpád Illés, Gabriel Etienne, Julio Delgado, Bryone J Kuss, Constantine S Tam, Zoltán Gasztonyi, Fritz Offner, Scott Lunin, Francesco Bosch, Matthew S Davids, Nicole Lamanna, Ulrich Jaeger, Paolo Ghia, Florence Cymbalista, Craig A Portell, Alan P Skarbnik, Amanda F Cashen, David T Weaver, Virginia M Kelly, Barry Turnbull, Stephan Stilgenbauer
• Journal: Blood (Blood) Vol. 132 Issue 23 Pg. 2446-2455 (12 06 2018) ISSN: 1528-0020 [Electronic] United States
• PMID: 30287523 (Publication Type: Clinical Trial, Phase III, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 by The American Society of Hematology.

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Isoquinolines
• Purines
• TP53 protein, human
• Tumor Suppressor Protein p53
• duvelisib
• ofatumumab

Topics

• Adult
• Aged
• Aged, 80 and over
• Antibodies, Monoclonal (administration & dosage, adverse effects)
• Antibodies, Monoclonal, Humanized
• Chromosome Deletion
• Chromosomes, Human, Pair 17
• Disease-Free Survival
• Double-Blind Method
• Female
• Humans
• Isoquinolines (administration & dosage, adverse effects)
• Leukemia, Lymphocytic, Chronic, B-Cell (drug therapy, genetics, mortality)
• Male
• Middle Aged
• Purines (administration & dosage, adverse effects)
• Recurrence
• Smith-Magenis Syndrome
• Survival Rate
• Tumor Suppressor Protein p53 (genetics)