Combination of ublituximab, umbralisib and ibrutinib for patients with leukemia and lymphoma

This study aimed to investigate the safety and effectiveness of ublituximab, umbralisib and ibrutinib combination in patients with non-Hodgkin lymphoma (NHL). This study concluded that this combination appears safe and effective for these patients. 

Patients with NHL are often treated with targeted therapies. Ublituximab and umbralisib are new targeted therapies. They are currently used in clinical trials. Ibrutinib (Imbruvica) is another targeted therapy. It has been approved and is commonly used to treat patients with chronic lymphocytic leukemia (CLL).

Some patients with NHL do not respond to standard therapies or relapse after treatment. It is important to evaluate new treatment combinations for these patients. It is not known if the combination of ublituximab, umbralisib and ibrutinib (UUI) would be safe and effective for treating patients with relapsed or unresponsive NHL.  

This study involved 46 patients with CLL or relapsed/refractory NHL. They were treated with UUI combination. 24 patients received treatment in 28-day cycles. They received progressive doses of umbralisib (400, 600 and 800mg) and fixed doses of ublituximab (900mg) and ibrutinib (420mg for CLL and 560mg for NHL). They received treatment until disease progression or intolerance. 22 patients then received the recommended dose of the drug combination that was calculated from the previous phase of the study. The average treatment duration was 16 months.

The recommended dose from the first phase was umbralisib 800 mg orally once daily plus ibrutinib orally once daily and intravenous ublituximab 900 mg administered on days 1, 8, and 15 of cycle 1, day 1 of cycles 2–6, and on day 1 of cycles 9 and 12. 37 of 44 patients (84%) achieved an overall response. Response to treatment lasted for an average of 21.8 months. Survival without cancer growing or spreading was 38.2 months, on average.

The most common side effects were diarrhea in 59%, fatigue in 50%, and infusion-related reaction in 43% of patients. Dizziness and nausea were also reported in 37% of patients, and cough in 35%. The most common severe and life-threatening side effects included low white blood cell count (22%) and cellulitis (bacterial infection in skin) in 13% of patients. 

This study concluded that the UUI combination appears safe and effective in patients with CLL or NHL. 

This was only a phase I study (the first study of its kind). It included a small number of patients and a short follow-up. Further studies are needed to fully understand this treatment combination.