General AML

VIALE-A study of venetoclax plus azacitidine meets dual primary endpoints

On November 21, 2018, the United States Food & Drug Administration (FDA) granted accelerated approval to venetoclax in combination with azacitidine, decitabine or low-dose cytarabine (LDAC) for patients with newly diagnosed acute myeloid leukemia (AML) ineligible for intensive induction therapy due to older age (≥ 75 years) or coexisting medical conditions. This decision was dependent upon the confirmatory phase III clinical trials, VIALE-A and VIALE-C.1

It has been announced that the VIALE-A trial (NCT02993523), comparing venetoclax plus azacitidine to placebo plus azacitidine, has met the dual primary endpoints, with the combination therapy leading to a significant improvement in overall survival (OS) and composite complete remission rate.2

VIALE-A2,3
  • Phase III, randomized, double-blind, placebo-controlled, multicenter study
  • Patients with previously untreated AML who were ineligible for intensive induction chemotherapy (n = 431) were randomized 2:1 to
    • venetoclax (400 mg, orally, once daily on Days 1–28) + azacitidine (75 mg/m2, subcutaneously [SC] or intravenously [IV], once daily on Days 1–7)
    • placebo (orally, as per venetoclax dosing schedule) + azacitidine (as above)
  • Patients were defined as ineligible for intensive induction chemotherapy due to
    • age 75 years
    • comorbidities that are incompatible with intensive chemotherapy
  • Primary endpoints: OS and composite complete remission rate (complete response [CR] plus CR with incomplete blood count recovery)
  • Secondary endpoints: event-free survival, CR and CR with partial hematologic recovery, transfusion independence, and patient reported outcomes
VIALE-C4

In February 2020, it was announced that the phase III VIALE-C trial (NCT03069352), comparing venetoclax plus LDAC to placebo plus LDAC, failed to meet the primary endpoint of a significant improvement in OS in patients with newly diagnosed AML who are ineligible for intensive induction chemotherapy.

Future directions

The full results from VIALE-A and VIALE-C are expected to be presented at an upcoming medical congress. The FDA has not yet commented about whether the results of the VIALE-A or VIALE-C trial will impact the current approval.1

The AML Hub are currently focusing on an editorial theme of ‘novel combination therapies using targeted agents’. Venetoclax is a targeted agent that inhibits Bcl-2 and is under investigation in various combination therapies, such as with the hypomethylating agents azacitidine and decitabine, as discussed here. To learn more about targeted agent combinations in AML, click here.

References
  1. FDA approves venetoclax in combination for AML in adults. https://www.fda.gov/drugs/fda-approves-venetoclax-combination-aml-adults. Updated Dec 14, 2018. [Accessed Mar 24, 2020]

  2. Roche announces Venclexta/Venclyxto combination improved overall survival in people with previously untreated acute myeloid leukaemia. https://www.roche.com/media/releases/med-cor-2020-03-23.htm. Published Mar 23, 2020. [Accessed Mar 24, 2020]

  3. Clinicaltrials.gov. A study of venetoclax in combination with azacitidine versus azacitidine in treatment naïve subjects with acute myeloid leukemia who are ineligible for standard induction therapy. https://clinicaltrials.gov/ct2/show/NCT02993523. Updated Feb 28, 2020. [Accessed Mar 24, 2020]

  4. PR Newswire. AbbVie provides update from phase 3 study evaluating VENCLEXTA® (venetoclax) in combination with low-dose cytarabine in newly-diagnosed patients with acute myeloid leukemia (AML). https://www.prnewswire.com/news-releases/abbvie-provides-update-from-phase-3-study-evaluating-venclexta-venetoclax-in-combination-with-low-dose-cytarabine-in-newly-diagnosed-patients-with-acute-myeloid-leukemia-aml-301013711.html. Published Feb 28, 2020. [Accessed Mar 24, 2020]

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