Ibrutinib as Initial Therapy for Patients with Chronic Lymphocytic Leukemia

• Published in: The New England journal of medicine Vol. 373; no. 25; pp. 2425 - 2437
• Main Authors: Burger, Jan A, Tedeschi, Alessandra, Barr, Paul M, Robak, Tadeusz, Owen, Carolyn, Ghia, Paolo, Bairey, Osnat, Hillmen, Peter, Bartlett, Nancy L, Li, Jianyong, Simpson, David, Grosicki, Sebastian, Devereux, Stephen, McCarthy, Helen, Coutre, Steven, Quach, Hang, Gaidano, Gianluca, Maslyak, Zvenyslava, Stevens, Don A, Janssens, Ann, Offner, Fritz, Mayer, Jiří, O’Dwyer, Michael, Hellmann, Andrzej, Schuh, Anna, Siddiqi, Tanya, Polliack, Aaron, Tam, Constantine S, Suri, Deepali, Cheng, Mei, Clow, Fong, Styles, Lori, James, Danelle F, Kipps, Thomas J
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 17.12.2015
• Subjects: Adenine - analogs & derivatives; Aged; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Chemotherapy; Chlorambucil; Chlorambucil - adverse effects; Chlorambucil - therapeutic use; Chronic lymphocytic leukemia; Clinical trials; Cough; Diarrhea; Diarrhea - chemically induced; Disease-Free Survival; Fatigue; Fatigue - chemically induced; Female; Hemoglobin; Hemorrhage; Humans; Immunosuppression; Immunotherapy; Inhibitor drugs; Leukemia; Leukemia, Lymphocytic, Chronic, B-Cell - drug therapy; Leukemia, Lymphocytic, Chronic, B-Cell - mortality; Lymphatic leukemia; Lymphoma; Male; Myelosuppression; Nausea; Neutropenia; Neutropenia - chemically induced; Piperidines; Pyrazoles - adverse effects; Pyrazoles - therapeutic use; Pyrimidines - adverse effects; Pyrimidines - therapeutic use; Survival; Survival Analysis; Vomiting
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1509388

The Bruton's tyrosine kinase inhibitor ibrutinib was compared with the alkylating agent chlorambucil in patients with chronic lymphocytic leukemia. Ibrutinib was associated with a higher response rate, longer duration of response, and longer overall survival. Chronic lymphocytic leukemia (CLL) is the most common leukemia among adults in Western countries; it affects primarily older persons, with a median age at diagnosis of 72 years. 1 , 2 Chlorambucil has been a standard first-line therapy in CLL, especially for older patients or those with coexisting conditions. 1 , 3 Until recently, no treatment was clearly superior to chlorambucil in this population. 3 – 7 Fludarabine or bendamustine has been associated with higher response rates and longer progression-free survival than those with chlorambucil, but both have also been associated with higher rates of toxic effects, and neither has provided overall survival benefit. 3 , 5 , . . .