In a large multicenter retrospective study that we led, we reviewed the outcomes following sequential treatment with first-line BR, followed by second-line BTK inhibitor using an intention-to-treat framework analysis. The results we found that with the sequential treatment, the cumulative progression-free survival from first-line BR and second-line BTK inhibitor, numerically looks similar to those we can achieve with combination therapy with either ibrutinib or acalabrutinib from the two landmark trials...
In a large multicenter retrospective study that we led, we reviewed the outcomes following sequential treatment with first-line BR, followed by second-line BTK inhibitor using an intention-to-treat framework analysis. The results we found that with the sequential treatment, the cumulative progression-free survival from first-line BR and second-line BTK inhibitor, numerically looks similar to those we can achieve with combination therapy with either ibrutinib or acalabrutinib from the two landmark trials. They’re not exactly the same numbers, but they’re close enough, partly because in the retrospective cohort, the maintenance rituximab was up to the investigator’s choice, where it is part of the design in the landmark trials. So factoring that piece, I think the sequential treatment probably can get to the similar mileage as with the combination treatment. Now, there’s no randomized data to prove that, so in practice, how do we choose? We think for the low-risk patients, the sequential treatment approach is very reasonable. You use a BR in the front line with R maintenance, reserve a BTK inhibitor for the second line. We believe with this approach for the low-risk patients, you can get to the same PFS eventually. Now for the patients with high-risk features, such as high Ki-67, TP53 mutated, blast variant, et cetera, for those patients, the combination therapy upfront will be very reasonable.
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