This was an intelligent combination that was chosen for patients with comorbidities. CLL, chronic lymphocytic leukaemia, is a disease of the elderly, as you know, and old age comes with comorbidities so you are not in the position to treat very aggressively. What they did is they took an intelligent combination, venetoclax, an anti-BCL2 agent, and obinutuzumab, with a completely different mode of action, an antibody against CD20 that is on the CLL cells. They combined the two, which appeared to be feasible from a toxicity point of view, and compared this new combination of two most effective drugs with different modes of action with a control arm – the same antibody plus a tablet of chlorambucil, old-fashioned treatment. There was a significant difference in favour of the venetoclax/obinutuzumab arm with more than 50% less chance of progression at two years and not a different toxicity profile between arms.
So I think this is another major step forward. It was published in The Lancet and it will be approved, it has already been approved almost, by the FDA, it will be approved by EMA, and can be seen as standard of care in the years to come for elderly patients with comorbidities and chronic lymphocytic leukaemia. Great work by the German CLL group.