Dr Opat on the Accessibility of Sonrotoclax Plus Zanubrutinib in R/R CLL/SLL

Stephen Opat, MBBS, director, Clinical Hematology, head, Department of Hematology, School of Clinical Sciences, Monash Health, Monash University; founder, chair, the Australasian Lymphoma and Related Diseases Registry, lead investigator, the Melbourne Genomics Health Alliance Lymphoma Flagship, discusses the accessibility and clinical implications of the combination of sonrotoclax (BGB-11417) and zanubrutinib (Brukinsa) in the treatment of patients with relapsed/refractory chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL).

Updated findings from the phase 1 BGB-11417-101 study (NCT04277637), which were presented at the 2024 EHA Congress, showed that across all dose levels, patients treated with the combination therapy experienced an overall response rate (ORR) of 97% across all dose levels, including a complete response (CR) or CR with incomplete hematologic recovery rate (CRi) of 57%. Notably, patients treated with the recommended phase 2 dose of sonrotoclax at 320 mg, the ORR was 100%, and the CR/CRi rate was 73%. Regarding safety, no dose-limiting toxicities were reported, and the maximum tolerated dose of sonrotoclax was not reached.

One of the significant benefits of this combination is its oral administration, eliminating the need for frequent hospital visits for intravenous (IV) infusions, Opat explains. This level of convenience can enhances patient compliance and quality of life, making it a more accessible treatment option for patients who might face logistical challenges or have limited travel access to treatment centers, he continues.

Opat emphasizes that this regimen could be beneficial in clinical practice, particularly in community settings where access to hospital-based treatments might be limited. Monitoring blood tests is also necessary to ensure patient safety and manage potential adverse effects, Opat notes. However, the simplicity of this regimen compared with IV therapies could facilitate its integration into routine clinical practice, he says.

Opat explains that ongoing phase 3 trials will provide further insights into the effectiveness of the combination compared with current standard-of-care treatments for patients with CLL/SLL. An ongoing phase 3 trial (NCT06073821) is evaluating sonrotoclax plus zanubrutinib vs venetoclax (Venclexta) plus obinutuzumab (Gazya) in patients with treatment-naive CLL/SLL.