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FLAIR trial: MRD-directed ibrutinib + venetoclax vs FCR in patients with CLL

By Abhilasha Verma

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Jan 28, 2025

Learning objective: After reading this article, learners will be able to cite a new clinical development in chronic lymphocytic leukemia.



FLAIR (ISRCTN01844152), a multicenter, open-label, parallel-group, randomized, controlled, phase III trial, evaluated the efficacy and safety of Ibr + Ven, with treatment duration guided by MRD status, compared to FCR in patients with previously untreated CLL.1 Results from the trial were published in the New England Journal of Medicine by Talha et al.1 


Key learnings
With a median follow-up of 43.7 months, the estimated 3-year PFS and OS for Ibr + Ven vs FCR were 97.2% vs 76.8 and 98% vs 93%, respectively. OS and PFS was improved across all subgroups except patients with mutated IGHV.
At 3 years, 58.0% of patients treated with Ibr + Ven had stopped therapy due to uMRD. After 5 years, 65.9% of patients had uMRD in BM and 92.7% had uMRD in PB.
The percentage of patients with cardiac SAEs was higher with Ibr + Ven vs FCR (10.7% vs 0.4%).
These results provide evidence for the efficacy and safety of MRD-directed Ibr + Ven therapy, which could facilitate personalized treatment durations for patients with untreated CLL. Subgroup analysis highlights the benefits for patients who may have poorer outcomes with available treatments.

Abbreviations: BM, bone marrow; CLL, chronic lymphocytic leukemia; FCR, fludarabine-cyclophosphamide-rituximab; Ibr, ibrutinib; OS, overall survival; PB, peripheral blood; PFS, progression-free survival; Ven, venetoclax; SAE, serious adverse event; uMRD, undetectable measurable residual disease.

References

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