Matthew Steven Davids, MD, MMSc, on Venetoclax Plus R-EPOCH to Treat Richter’s Syndrome

A multicenter phase II study of venetoclax (Venclexta) plus dose-adjusted R-EPOCH (rituximab [Rituxan], etoposide phosphate [Etopophos], prednisone [Rayos], vincristine sulfate [Marqibo], cyclophosphamide, and doxorubicin hydrochloride) in patients with chronic lymphocytic leukemia (CLL) who developed Richter’s Syndrome found the treatment combination to be effective in this patient population.

Based on the study results, presented at the 2020 American Society of Clinical Oncology (ASCO) Virtual Scientific Program, Matthew Steven Davids, MD, MMSc, an attending physician in the Lymphoma Program of the Division of Hematologic Malignancies at the Dana-Farber Cancer Institute, along with his fellow investigators believe that this novel approach is worthy of further study in patients who develop Richter’s Syndrome. Moreover, a future study expansion of venetoclax plus CHOP (cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate [Marqibo], and prednisone [Rayos]) is already planned.

Davids, who is also the associate director of the Dana-Farber CLL Center, spoke with CancerNetwork® about the implications of the phase II study and how this study may lead to a new approach in treating patients with Richter’s syndrome. 

Transcription:

So I think right now, we don’t really have a standard of care for Richter’s patients. We typically do start by using chemotherapy, and although our study is a small one, it is a multi-center study. We were able to replicate the results at 3 different centers. And so, I think it’s reasonable to discuss the possibility of adding venetoclax to chemotherapy, such as R-EPOCH, for patients with Richter’s based on our results. I think as we get more patients treated, that will become easier to justify in terms of the level of evidence. 

This is something that we hope the (National Comprehensive Cancer Network; NCCN) actually will consider as a listing within the guidelines, because remember that Richter’s is a very rare disease. So this is not an area where I expect to see larger randomized trials, certainly not phase III trials. And so, this may end up being the level of evidence that we have to justify a new approach to treating Richter’s patients.