Dr. Flinn on the iNNOVATE Trial in Waldenstrom Macroglobulinemia

Ian Flinn, MD, PhD, director of the Blood Cancer Research Program, Sarah Cannon Research Institute, discusses the iNNOVATE trial in Waldenstrom macroglobulinemia.

There have been many updates in hematology in the past year, one of which came from the results of the iNNOVATE trial in Waldenstrom macroglobulinemia. In the trial, patients either received rituximab (Rituxan) or rituximab and ibrutinib (Imbruvica). Patients enrolled in the trial were very heterogenous, explains Flinn. Previously untreated patients, as well as those who received prior therapy, were eligible for the trial.

There was a substantial improvement in both the depth of response and overall response in patients who received the combination compared with single-agent rituximab, says Flinn. In addition to the response rate, there was a substantial difference in progression-free survival between the 2 arms.

Surprisingly, the incidence of atrial fibrillation was 12% in the ibrutinib arm compared to 1% with single-agent rituximab. Though ibrutinib is associated with atrial fibrillation, physicians have never seen it manifest on such a large scale. This may be attributed to a foundational difference in the disease, explains Flinn.