Comparable effectiveness of CPX-351 and venetoclax plus HMA in older AML patients

Liposomal daunorubicin/cytarabine (CPX-351) therapy did not result in different overall survival (OS) outcomes or response rates than venetoclax plus hypomethylating agent (HMA) therapy in patients with acute myeloid leukaemia (AML) between 60 and 75 years of age in this retrospective, real-world study. Subgroup analyses displayed an advantage in OS for TP53-positive patients who were treated with CPX-351 [1].

Both CPX-351 and venetoclax plus an HMA combination therapy have demonstrated to improve OS in older patients with AML [2,3]. Dr Justin Grenet (Weill Cornell Medical Center, NY, USA) and colleagues conducted a real-world, multicentre, retrospective chart review to compare the effectiveness of CPX-351 (n=211) versus venetoclax plus HMA (n=226). Primary outcomes were response rate, OS, and relapse-free survival. Dr Grenet explained that CPX-351 therapy is usually prescribed to younger patients who are deemed fit enough to withstand intensive chemotherapy, whereas venetoclax plus HMA is mostly prescribed in older, frailer patients. The research team was mostly interested to compare treatment results in patients between 60 and 75 years of age, the age category that shows the highest treatment overlap.

In patients between 60 and 75 years of age, there was no significant difference regarding OS between the 2 treatment regimens (logrank-P=0.3375), despite the higher rates of haematopoietic stem cell transplantations (HSCT) in the CPX-351 arm compared with the venetoclax plus HMA arm (47.7% vs 19.0%; P<0.001). Moreover, response rates did not favour one treatment over the other in this age category (59.2% vs 54.0%, respectively; P=0.41). Subgroup analyses displayed an advantage of CPX-351 therapy in patients between 60 and 75 years who were TP53-positive (HR 0.66; P=0.013). Strata differentiating for prior myeloid malignancy, prior HMA use, or European LeukemiaNet (ELN) risk classification did not show superiority of one treatment regimen over the other.

Dr Grenet argued that the treatment regimens display comparable effectiveness in patients with AML between 60 and 75 years. Currently, the team is investigating comorbidities and pre-induction and post-induction fitness scores in the study population to further analyse which treatment regimen provides the most benefits for each subgroup of patients.

1. Grenet J, et al. Comparing Outcomes between Liposomal Daunorubicin/Cytarabine (CPX-351) and HMA+Venetoclax As Frontline Therapy in Acute Myeloid Leukemia. Abstract 32, ASH 2021 Annual Meeting, 11–14 December.
2. Lancet JE, et al. J Clin Oncol. 2018;36(26):2684–2692.
3. DiNardo CD, et al. N Engl J Med 2020;383:617–629.

 

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Posted on 4 February, 2022