Idelalisib

【前言】瘤内浸润的Treg细胞亚群复杂，通过不同途径促进免疫抑制微环境的塑造，是肿瘤。也因此，很多已上市的抗体疗法都和Treg作用相关，也有希望特异性影响Treg的疗法在开发中。Front. Immunol.（一）通过表面蛋白特异性耗竭Treg进入临床阶段的疗法包括：靶点药物/管线名称其他CD25daclizumab人源IgG1单抗basiliximabADCT-301ADCRO7296682IL-2非阻断抗体RM-1995近红外光免疫疗法Denileukin diftitox重组免疫毒素CTLA-4Ipilimumab人源化IgG1单抗ADU-1604NurulimabTicilimumab人源化IgG2单抗XMAB20717CTLA-4/PD-1双特异性单抗XMAB22841CTLA-4/LAG-3双特异性单抗ATOR-1015CTLA-4/OX40双特异性单抗OX40MEDI6383人OX40L-IgG4 Fc融合蛋白PF-04518600激动型单抗BMS 986178BGB-A445MEDI6469MOXR0916MEDI0562GITRMEDI1873激动型六价GITR配体融合蛋白TRX518人源化、非耗竭性、琼脂糖基IgG1单抗MK-1248人源化IgG4单抗BMS-986156人源IgG1单抗GWN323ICOSJTX-2011激动型人源化IgG1单抗KY1044MEDI-570Fc段糖基化人源化单抗GSK3359609XMAB23104ICOS/PD-1双特异性单抗肿瘤浸润Treg抑制相关的表面分子表达包括：CD25、CTLA-4、PD-1、ICOS、LAG-3和TIGIT；TNF受体超家族GITR、4-1BB和OX-40；趋化因子受体CCR4、CCR5和CCR10。Treg细胞还可以通过释放IL-10、TGF-β和IL-35等抗炎细胞因子来抑制TME的免疫反应。几种CTLA-4单克隆抗体还可以通过ADCC效应杀伤Ti-Tregs。然而，一些临床研究表明，在CTLA-4抗体给药后，肿瘤内的Tregs数量不会减少，反而促进了Ti-Tregs的CD28依赖性扩增。此外，由于微环境中的其他免疫细胞也表达CTLA-4，因此非选择性靶向CTLA-4可能会无意中减少抗肿瘤免疫细胞。许多研究已经探索了以CD25为靶点的抗肿瘤策略，或者将IL-2与细胞毒分子或CD25 ADC结合以耗尽Treg细胞。然而，这些方法在不同的背景下表现出不同的有效性。（二）减少Tregs募集：抑制趋化因子信号通路进入临床阶段的疗法包括：靶点药物/管线名称特征CCR4MogamulizumabFc段糖基化人源化单抗FLX475口服特异性激动剂CCR8GS-1811Fc段糖基化人源化单抗BAY3375968BMS-986340S-531011通过抑制趋化因子信号通路，Tregs在肿瘤中的积聚可以得到缓解(肿瘤浸润Treg的趋化和代谢特征)。很早就有在小鼠实验中实验CCR10或CCR5单抗，显示能显著延缓肿瘤生长。CCR4单抗还能通过ADCC效应特异性地清除Treg。（三）减弱Tregs相关细胞间信号进入临床阶段的疗法包括：靶点药物/管线名称特征PI3K8Parsaclisib小分子抑制剂IOA-244AZD8186LCKDasatinib多靶点TKIImatinibTreg细胞通过高表达CD39和CD73来适应微环境，最终将瘤内的ATP转化为腺苷。CD39：当ATP作用于Treg的P2XR时，可以诱导Treg的凋亡并抑制Treg的功能(172,173)。CD39可降低TME中的ATP水平，间接保护Treg细胞免受ATP诱导的细胞凋亡。CD73：提高了微环境中的腺苷浓度。腺苷与效应T细胞膜上的A2aR和A2bR结合，从而抑制其活性。IDO：作为一种色氨酸消耗酶，可导致TME内色氨酸水平降低，从而影响T细胞的激活及其抗肿瘤能力。值得注意的是，给予免疫检查点抑制剂后，TME中过表达IDO，同样导致Tonvs功能障碍，Tregs和MDSCs激活和增殖水平提高，建立了免疫抑制环境。不过，尽管Epacadostat在内的几种口服IDO1抑制剂在过去几年中已进入人体临床试验，没有出现重大安全问题，但其单药试验并未达到客观疗效。（四）靶向Treg代谢进入临床阶段的疗法包括：靶点药物/管线名称特征CD36VT1021多为抑制剂MCT1AZD3965IDOEpacadostatNLG802GDC-0919CD73LY3475070小分子酶抑制剂CPI-006MEDI9447Sym024CD39TTX-030SRF617肿瘤细胞与TI-Tregs有一些共同的代谢特征。在人源卵巢癌、结肠癌和黑色素瘤的小鼠模型中，ROS可诱导Tregs的凋亡。此外，特定浓度的乳酸为TI-Tregs提供碳源以产生磷酸烯醇式丙酮酸(糖酵解的中间体)。然而，目前尚不清楚在TME中限制Treg代谢最终对免疫有利还是有害。正面作用的靶点包括CD36，例如在黑色素瘤移植小鼠模型中，CD36拮抗剂破坏脂质代谢，从而选择性地耗尽Ti-Tregs，恢复抗体对PD-1的效力，而不会产生严重的自身免疫反应。PI3K-AKT-mTOR通路作为协调糖酵解的枢纽，也是Treg代谢靶点之一。黑色素瘤小鼠模型中，雷帕霉素和GO-Y030(mTOR抑制剂)可通过限制葡萄糖摄取和糖酵解，来限制Tregs的数量和功能。此外，当Poly-G3和ssRNA40在体外与人卵巢癌细胞共同培养时，可以刺激TLR8信号，干扰mTOR-HIF-1α诱导的葡萄糖代谢，降低Treg的功能。在胃癌临床前模型中，PI3K-β抑制剂GSK2636771减少了Tregs中游离FA的产生、脂肪的吸收和代谢，抑制了它们的迁移和功能。此类药物还通过信号传递、表观遗传调节和翻译后修饰对Treg产生影响。例如，idelalisib(第一种用于人类慢性淋巴细胞白血病的PI3K-δ抑制剂)可选择性地阻止T细胞分化为Treg细胞和后续分泌IL-10的能力。脂质代谢：主要依赖脂肪酸合成(FAS)和FAO来扰乱肿瘤浸润Treg细胞的代谢适应性。在小鼠黑色素瘤模型中，CD36等脂质代谢靶点比CTLA-4和OX40等传统靶点显示出更好的特异性，阻止了功能性Tregs的积累，而不会系统性地耗竭全身Tregs。抗CD36和抗PD-1阻断的联合治疗可防止小鼠在治疗后出现严重的自身免疫。氨基酸代谢：通过吲哚胺2，3-双加氧酶(IDO)靶向犬尿氨酸途径有可能消除小鼠胶质母细胞瘤模型中的Tregs。不过几种IDO1抑制剂目前尚无较好数据，也少有进入临床阶段的管线。（五）靶向TME进入临床阶段的疗法包括：靶点药物/管线名称特征VEGFBevacizumabRamucirumabVEGFR2单抗Sorafenib多靶点小分子抑制剂TGF-βGalunisertibTGFR1抑制剂M7824PD-1/TGFβTrapTreg在肿瘤微环境中对血管新生具有极大的促进作用。小结：Treg细胞的特征分子和代谢途径并不是它们自己独有，而是与效应T细胞和外周Tregs共享靶点。因此，全身给药方法可能导致消除或抑制肿瘤外的非肿瘤Tregs以及其他效应细胞，不仅抑制pTreg功能，破坏免疫动态平衡，引发自身免疫性炎症，而且还减弱抗肿瘤效率。也就是说，要么找到表达水平具有足够特异性的单一靶点，要么采用复合靶点以改善这种表达差异。参考文献：1.Qin D, Zhang Y, Shu P, Lei Y, Li X and Wang Y (2024) Targeting tumor-infiltrating tregs for improved antitumor responses. Front. Immunol. 15:1325946. doi: 10.3389/fimmu.2024.13259462.Wang Y, Huang T, Gu J, Lu L. Targeting the metabolism of tumor-infiltrating regulatory T cells. Trends Immunol. 2023 Aug;44(8):598-612. doi: 10.1016/j.it.2023.06.001. 3.Christopher Tay, Atsushi Tanaka, Shimon Sakaguchi,Tumor-infiltrating regulatory T cells as targets of cancer immunotherapy,Cancer Cell,Volume 41, Issue 3,2023.doi:10.1016/j.ccell.2023.02.014.

Matching adjusted indirect comparison addresses key questions and limitations associated with previously presented analysis and suggests efficacy advantage of BRUKINSA vs acalabrutinib BASEL, Switzerland & BEIJING & CAMBRIDGE, Mass.--(BUSINESS WIRE)-- BeiGene, Ltd. (Nasdaq: BGNE; HKEX: 06160; SSE: 688235), a global oncology company, today announced a new matching adjusted indirect comparison (MAIC) of the efficacy of BRUKINSA® (zanubrutinib) versus acalabrutinib in relapsed or refractory (R/R) chronic lymphocytic leukemia (CLL) based on data from the Phase 3 ALPINE and Phase 3 ASCEND trials. The analysis suggests a progression-free survival and complete response advantage for BRUKINSA versus acalabrutinib, as well as potentially improved overall survival. These data will be presented during the 28th Annual International Congress on Hematologic Malignancies® in Miami from February 29 - March 3. “The CLL landscape is evolving rapidly, and this MAIC provides timely comparative effectiveness data for physicians, and reinforces zanubrutinib role as a foundational CLL treatment via a robust evaluation of the efficacy in the ASCEND and ALPINE studies; the presented analysis not only accounts for differences in key patient characteristics, but also clarifies the impact COVID-19 may have had on study outcomes,” said Mazyar Shadman, M.D. M.P.H, Study Author and Innovators Network Endowed Chair, Associate Professor of Hematology and Oncology, Lymphoid Malignancies and Immunotherapy, Fred Hutch Cancer Center and University of Washington. “Head-to-head randomized clinical trials are the gold standard when it comes to evaluating the potential impact of individual treatments for patients. MAICs are intended to be hypothesis-generating, provided they are conducted with appropriate rigor to minimize potential biases.” In this MAIC, individual patient-level data from ALPINE was matched against the aggregate data from ASCEND. An unanchored MAIC was used due to the lack of a common comparator arm between the ALPINE and ASCEND trials. Given the differences in the timing of the studies, with respect to the onset of the COVID-19 pandemic, the analysis adjusted for the impact of COVID-19 in the ALPINE study. In a previously published MAIC of BRUKINSA versus acalabrutinib,1 there were significant limitations that precluded a robust efficacy comparison, including the exclusion of data from the final analysis of ALPINE, lack of adjustment for the impact of COVID-19 on the outcomes, lack of adjustment for key differences in patient characteristics, the effective sample size, and the exclusion of complete response rate and overall survival from the analysis. “BeiGene is committed to continuing to further our understanding of the efficacy and safety of our therapies and their potential to help patients among other options,” said Mehrdad Mobasher, M.D., M.P.H., Chief Medical Officer, Hematology at BeiGene. “This MAIC addresses key questions raised in a previously published analysis, presenting a more holistic representation of the efficacy associated with BRUKINSA versus acalabrutinib in relapsed or refractory chronic lymphocytic leukemia setting.” BRUKINSA is the only Bruton’s tyrosine kinase (BTK) inhibitor to demonstrate progression-free survival superiority vs ibrutinib in R/R CLL, as observed in the ALPINE trial.2 Acalabrutinib has demonstrated improvement in progression-free survival vs rituximab plus idelalisib/bendamustine in R/R CLL in the ASCEND trial and has also demonstrated progression-free survival noninferiority vs ibrutinib R/R CLL patients with chromosome 17p or 11q deletions in the ELEVATE-RR trial.3,4 The MAIC suggests that investigator-assessed progression-free survival was improved for BRUKINSA versus acalabrutinib in both the unadjusted population (HR=0.77 [95%CI: 0.55-1.07]), as well as the base case adjusted population (HR=0.68 [95%CI: 0.46-0.99]). Additionally, the odds ratio (OR) for complete response favored BRUKINSA over acalabrutinib in the unadjusted (OR=2.88 [95%CI: 1.18-7.02]) and base case adjusted populations (OR=2.90; [95%CI: 1.13-7.43]). Results for the sensitivity analysis were consistent with the base case. The overall survival trend remained consistently in favor of BRUKINSA. For additional details of the analysis, please refer to the full poster presentation. While MAIC analyses can be hypotheses-generating, in the absence of head-to-head data, the safety of a drug may be best evaluated using all available evidence across indications. A recent independent Mayo Clinic meta-analysis of 61 trials involving 6,959 patients who received ibrutinib plus an anti-CD20 antibody, acalabrutinib, and BRUKINSA extensively analyzed the adverse event profiles of the two therapies across several indications and reported key differences in the safety profiles of the two treatments.5 BRUKINSA is approved in 70 markets, including the U.S., China, EU, Great Britain, Canada, Australia, South Korea and Switzerland in selected indications, and it is under development for additional indications globally. The global BRUKINSA development program includes more than 5,000 subjects enrolled to date in 29 countries and regions. About MAICs Match adjusted indirect comparisons are intended to be hypothesis generating, and do not establish superior efficacy or safety of one drug over another. Results should be viewed in the context of study limitations and available clinical data. About ALPINE ALPINE is a randomized, global, Phase 3 trial (NCT03734016) comparing BRUKINSA with ibrutinib in previously treated patients with R/R CLL or small lymphocytic lymphoma (SLL). In the trial, a total of 652 patients across Europe (60%), the United States (17%), China (14%), and New Zealand and Australia (9%) were randomized to receive BRUKINSA (160 mg orally twice daily) or ibrutinib (420 mg orally once daily) until disease progression, death, or unacceptable toxicity. The primary endpoint of overall response rate (ORR) was assessed by both investigator and independent review committee (IRC) using the modified 2008 iwCLL guidelines, with modification for treatment-related lymphocytosis for patients with CLL, and as per Lugano Classification for non-Hodgkin’s lymphoma for patients with SLL. Key secondary endpoints included PFS and the rate of atrial fibrillation or flutter; other secondary endpoints included duration of response, overall survival, and incidence of adverse events. There was a pre-specified hierarchical testing of non-inferiority followed by superiority for ORR as assessed by investigator and IRC. As ORR superiority was demonstrated, progression-free survival was tested for noninferiority and superiority under hierarchical testing. In an extended follow-up of the ALPINE study at a median follow-up of 39 months, BRUKINSA showed sustained PFS improvement versus ibrutinib (HR: 0.68 [95% CI, 0.53-0.86] P=0.0011) among R/R CLL/SLL patients, with durable PFS benefit observed across key subgroups, including patients with 17p deletion or TP53 mutation (HR: 0.52 [95% CI, 0.33-0.83] P=0.0047). PFS benefit was consistent across multiple sensitivity analyses, demonstrating that PFS advantage with BRUKINSA was primarily driven by efficacy, and not better tolerability. The overall safety and tolerability pro consistent with previous ALPINE analyses, including persistently lower rates of cardiovascular events reported with BRUKINSA. The most commonly reported treatment emergent adverse events (≥20%) with BRUKINSA were COVID-19-related infection, neutropenia, hypertension, and upper respiratory tract infection.6 About BRUKINSA® (zanubrutinib) BRUKINSA is a small molecule inhibitor of BTK designed to deliver complete and sustained inhibition of the BTK protein by optimizing bioavailability, half-life, and selectivity. With differentiated pharmacokinetics compared with other approved BTK inhibitors, BRUKINSA has been demonstrated to inhibit the proliferation of malignant B cells within a number of disease-relevant tissues. U.S. Indications and Important Safety Information for BRUKINSA (zanubrutinib) INDICATIONS BRUKINSA is a kinase inhibitor indicated for the treatment of adult patients with: Chronic lymphocytic leukemia or small lymphocytic lymphoma Waldenström’s macroglobulinemia Mantle cell lymphoma (MCL) who have received at least one prior therapy Relapsed or refractory marginal zone lymphoma (MZL) who have received at least one anti-CD20-based regimen The MCL and MZL indications are approved under accelerated approval based on overall response rate. Continued approval for these indications may be contingent upon verification and description of clinical benefit in confirmatory trials. IMPORTANT SAFETY INFORMATION Warnings and Precautions Hemorrhage Fatal and serious hemorrhage has occurred in patients with hematological malignancies treated with BRUKINSA monotherapy. Grade 3 or higher hemorrhage, including intracranial and gastrointestinal hemorrhage, hematuria and hemothorax have been reported in 3.6% of patients treated with BRUKINSA monotherapy in clinical trials, with fatalities occurring in 0.3% of patients. Bleeding of any grade, excluding purpura and petechiae, occurred in 30% of patients. Bleeding has occurred in patients with and without concomitant antiplatelet or anticoagulation therapy. Coadministration of BRUKINSA with antiplatelet or anticoagulant medications may further increase the risk of hemorrhage. Monitor for signs and symptoms of bleeding. Discontinue BRUKINSA if intracranial hemorrhage of any grade occurs. Consider the benefit-risk of withholding BRUKINSA for 3-7 days pre- and post-surgery depending upon the type of surgery and the risk of bleeding. Infections Fatal and serious infections (including bacterial, viral, or fungal infections) and opportunistic infections have occurred in patients with hematological malignancies treated with BRUKINSA monotherapy. Grade 3 or higher infections occurred in 24% of patients, most commonly pneumonia (11%), with fatal infections occurring in 2.9% of patients. Infections due to hepatitis B virus (HBV) reactivation have occurred. Consider prophylaxis for herpes simplex virus, pneumocystis jiroveci pneumonia, and other infections according to standard of care in patients who are at increased risk for infections. Monitor and evaluate patients for fever or other signs and symptoms of infection and treat appropriately. Cytopenias Grade 3 or 4 cytopenias, including neutropenia (22%), thrombocytopenia (8%) and anemia (7%) based on laboratory measurements, developed in patients treated with BRUKINSA monotherapy. Grade 4 neutropenia occurred in 11% of patients, and Grade 4 thrombocytopenia occurred in 2.8% of patients. Monitor complete blood counts regularly during treatment and interrupt treatment, reduce the dose, or discontinue treatment as warranted. Treat using growth factor or transfusions, as needed. Second Primary Malignancies Second primary malignancies, including non-skin carcinoma, have occurred in 13% of patients treated with BRUKINSA monotherapy. The most frequent second primary malignancy was non-melanoma skin cancer reported in 7% of patients. Other second primary malignancies included malignant solid tumors (5%), melanoma (1.2%), and hematologic malignancies (0.5%). Advise patients to use sun protection and monitor patients for the development of second primary malignancies. Cardiac Arrhythmias Serious cardiac arrhythmias have occurred in patients treated with BRUKINSA. Atrial fibrillation and atrial flutter were reported in 3.7% of 1550 patients treated with BRUKINSA monotherapy, including Grade 3 or higher cases in 1.7% of patients. Patients with cardiac risk factors, hypertension and acute infections may be at increased risk. Grade 3 or higher ventricular arrhythmias were reported in 0.2% of patients. Monitor for signs and symptoms of cardiac arrhythmias (e.g. palpitations, dizziness, syncope, dyspnea, chest discomfort), manage appropriately, and consider the risks and benefits of continued BRUKINSA treatment. Embryo-Fetal Toxicity Based on findings in animals, BRUKINSA can cause fetal harm when administered to a pregnant woman. Administration of zanubrutinib to pregnant rats during the period of organogenesis caused embryo-fetal toxicity, including malformations at exposures that were 5 times higher than those reported in patients at the recommended dose of 160 mg twice daily. Advise women to avoid becoming pregnant while taking BRUKINSA and for 1 week after the last dose. Advise men to avoid fathering a child during treatment and for 1 week after the last dose. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus. Adverse Reactions In this pooled safety population, the most common adverse reactions, including laboratory abnormalities, in ≥30% of patients who received BRUKINSA (N=1550) included decreased neutrophil count (42%), upper respiratory tract infection (39%), decreased platelet count (34%), hemorrhage (30%), and musculoskeletal pain (30%). Drug Interactions CYP3A Inhibitors: When BRUKINSA is co-administered with a strong CYP3A inhibitor, reduce BRUKINSA dose to 80 mg once daily. For coadministration with a moderate CYP3A inhibitor, reduce BRUKINSA dose to 80 mg twice daily. CYP3A Inducers: Avoid coadministration with strong or moderate CYP3A inducers. Dose adjustment may be recommended with moderate CYP3A inducers. Specific Populations Hepatic Impairment: The recommended dose of BRUKINSA for patients with severe hepatic impairment is 80 mg orally twice daily. Please see full U.S. Prescribing Information and U.S. Patient Information. About BeiGene BeiGene is a global oncology company that is discovering and developing innovative treatments that are more affordable and accessible to cancer patients worldwide. With a broad portfolio, we are expediting development of our diverse pipeline of novel therapeutics through our internal capabilities and collaborations. We are committed to radically improving access to medicines for far more patients who need them. Our growing global team of more than 10,000 colleagues spans five continents, with administrative offices in Basel, Beijing, and Cambridge, U.S. To learn more about BeiGene, please visit and follow us on LinkedIn and X (formerly known as Twitter). Forward-Looking Statements This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 and other federal securities laws, including statements regarding the potential of BeiGene’s therapies to help patients; the efficacy and safety of BRUKINSA versus acalabrutinib in patients with R/R CLL; BeiGene’s advancement, anticipated clinical development, regulatory submissions and commercialization of zanubrutinib, particularly as a treatment for R/R FL; and BeiGene’s plans, commitments, aspirations, and goals under the heading “About BeiGene.” Actual results may differ materially from those indicated in the forward-looking statements as a result of various important factors, including BeiGene's ability to demonstrate the efficacy and safety of its drug candidates; the clinical results for its drug candidates, which may not support further development or marketing approval; actions of regulatory agencies, which may affect the initiation, timing and progress of clinical trials and marketing approval; BeiGene's ability to achieve commercial success for its marketed medicines and drug candidates, if approved; BeiGene's ability to obtain and maintain protection of intellectual property for its medicines and technology; BeiGene's reliance on third parties to conduct drug development, manufacturing, commercialization, and other services; BeiGene’s limited experience in obtaining regulatory approvals and commercializing pharmaceutical products; BeiGene’s ability to obtain additional funding for operations and to complete the development of its drug candidates and achieve and maintain profitability; and those risks more fully discussed in the section entitled “Risk Factors” in BeiGene’s most recent annual report on Form 10-K, as well as discussions of potential risks, uncertainties, and other important factors in BeiGene's subsequent filings with the U.S. Securities and Exchange Commission. All information in this press release is as of the date of this press release, and BeiGene undertakes no duty to update such information unless required by law. To access BeiGene media resources, please visit our News & Media site. 1 Kittai AS, et al. A matching-adjusted indirect comparison of acalabrutinib versus zanubrutinib in relapsed or refractory chronic lymphocytic leukemia. Am J Hematol. 2023 Dec;98(12):E387-E390. doi: 10.1002/ajh.27110. Epub 2023 Oct 9. PMID: 37811799. 2 Brown JR, et al. Zanubrutinib or Ibrutinib in Relapsed or Refractory Chronic Lymphocytic Leukemia. N Engl J Med. 2023 Jan 26;388(4):319-332. doi: 10.1056/NEJMoa2211582. Epub 2022 Dec 13. PMID: 36511784. 3 Ghia P, et al. ASCEND: Phase III, Randomized Trial of Acalabrutinib Versus Idelalisib Plus Rituximab or Bendamustine Plus Rituximab in Relapsed or Refractory Chronic Lymphocytic Leukemia. J Clin Oncol. 2020 Sep 1;38(25):2849-2861. doi: 10.1200/JCO.19.03355. Epub 2020 May 27. PMID: 32459600. 4 Sharman JP, et al. Acalabrutinib with or without obinutuzumab versus chlorambucil and obinutuzmab for treatment-naive chronic lymphocytic leukaemia (ELEVATE TN): a randomised, controlled, phase 3 trial. Lancet. 2020 Apr 18;395(10232):1278-1291. doi: 10.1016/S0140-6736(20)30262-2. Erratum in: Lancet. 2020 May 30;395(10238):1694. PMID: 32305093; PMCID: PMC8151619. 5 Hwang S, et al. P632: COMPARISON OF TREATMENT-EMERGENT ADVERSE EVENTS OF ACALABRUTINIB AND ZANUBRUTINIB IN CLINICAL TRIALS IN B-CELL MALIGNANCIES: A SYSTEMATIC REVIEW AND META-ANALYSIS. Hemasphere. 2023 Aug 8;7(Suppl ):e47546cf. doi: 10.1097/01.HS9.0000969432.47546.cf. PMCID: PMC10428881. 6 J. R. Brown, et. Al. Extended Follow-up of ALPINE Randomized Phase 3 Study Confirms Sustained Superior Progression-Free Survival of Zanubrutinib Versus Ibrutinib for Treatment of Relapsed/Refractory Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma (R/R CLL/SLL). Blood 2023; 142 (Supplement 1): 202. doi: .