# ROSEWOOD: a phase II randomized study of zanubrutinib plus obinutuzumab versus obinutuzumab monotherapy in patients with relapsed or refractory follicular lymphoma

Source: https://onco.cc/key-papers/paper-rosewood-zanubrutinib-obinutuzumab-follicular-jco-2023/  
OnCo record `paper-rosewood-zanubrutinib-obinutuzumab-follicular-jco-2023` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding a targeted tablet to an antibody roughly halved the risk of progression in follicular lymphoma that had already returned twice.

## Summary

A randomised phase 2 study in patients with relapsed or refractory follicular lymphoma who had received two or more lines of therapy including an anti-CD20 antibody and an alkylating agent. 217 patients were randomised 2 to 1 to zanubrutinib with obinutuzumab (145) or obinutuzumab alone (72). The primary endpoint was overall response rate by independent central review.

At a median study follow-up of 20.2 months the primary endpoint was met: overall response rate was 69 per cent with the combination against 46 per cent with obinutuzumab alone (p = 0.001). The complete response rate was 39 against 19 per cent, the 18-month duration of response rate 69 against 42 per cent, and median progression-free survival 28.0 against 10.4 months (hazard ratio 0.50, 95 per cent confidence interval 0.33 to 0.75).

## Fields

- Kind: Key paper
- Last checked: 2026-10-01
- Also known as: ROSEWOOD; Zinzani 2023
- Tags: lymphoma-evidence
- Journal: Journal of Clinical Oncology
- Year: 2023
- DOI: 10.1200/JCO.23.00775
- Authors: Zinzani PL, Mayer J, Flowers CR, et al.
- Findings: Overall response rate by independent central review was 69 per cent with zanubrutinib and obinutuzumab against 46 per cent with obinutuzumab alone (p = 0.001).; Complete response rate was 39 per cent against 19 per cent.; The 18-month duration of response rate was 69 per cent against 42 per cent.; Median progression-free survival was 28.0 months against 10.4 months (hazard ratio 0.50, 95 per cent confidence interval 0.33 to 0.75).
- What it means: Evidence that the B-cell receptor pathway is worth attacking in follicular lymphoma when a Bruton tyrosine kinase inhibitor is paired with a type II CD20 antibody, after single-agent inhibitors had disappointed in this disease.
- Caveats: A randomised phase 2, not a phase 3: the result establishes activity rather than a position in a treatment sequence.; Obinutuzumab monotherapy is not a standard comparator in this setting, which inflates the apparent difference.; Median follow-up of 20.2 months, with no overall survival result.

## Sources

- Journal of Clinical Oncology 2023: https://doi.org/10.1200/JCO.23.00775
- PubMed: https://pubmed.ncbi.nlm.nih.gov/37506346/
- Europe PMC: https://europepmc.org/article/MED/37506346

## Connected records

- roadmaps: [Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting](https://onco.cc/roadmaps/lymphoma-roadmap/)
- cancers: [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/)
- fronts: [Immunotherapy](https://onco.cc/fronts/immunotherapy/), [Targeted Therapy](https://onco.cc/fronts/targeted-therapy/)
- targets: [BTK (Bruton tyrosine kinase)](https://onco.cc/targets/btk/), [CD20](https://onco.cc/targets/cd20/)
- drugs: [Obinutuzumab](https://onco.cc/drugs/obinutuzumab/), [Zanubrutinib](https://onco.cc/drugs/zanubrutinib/)
- pathways: [B-cell receptor / BTK signalling (to NF-κB)](https://onco.cc/pathways/bcr-signalling/)
- terms: [Complete response](https://onco.cc/terms/complete-response/), [Objective response rate (ORR)](https://onco.cc/terms/orr/)
- trials: [ROSEWOOD](https://onco.cc/trials/rosewood/)
- bottlenecks: [Too many combinations to test](https://onco.cc/bottlenecks/b-combination-space/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)

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