# ROSEWOOD

Source: https://onco.cc/trials/rosewood/  
OnCo record `rosewood` (Trial). 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 doubled the chance of the lymphoma shrinking and tripled the time before it grew again, in people whose follicular lymphoma had already returned twice.

## Summary

Follicular lymphoma was not a disease in which Bruton tyrosine kinase inhibitors had performed well as single agents, so ROSEWOOD tested zanubrutinib in combination with the type II anti-CD20 antibody obinutuzumab rather than alone. 217 patients with relapsed or refractory follicular lymphoma after at least two lines, including an anti-CD20 antibody and an alkylating agent, were randomised 2 to 1 to the combination (145) or to obinutuzumab alone (72).

At a median follow-up of 20.2 months the primary endpoint was met: overall response rate by independent central review was 69 per cent with the combination against 46 per cent with obinutuzumab alone (p = 0.001). Complete response 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 months against 10.4 (hazard ratio 0.50, 95 per cent confidence interval 0.33 to 0.75).

It is a randomised phase 2, so the comparator is an antibody that few would use alone in this setting, and the result establishes activity rather than a place in a sequence. It is nonetheless the clearest evidence that the Bruton tyrosine kinase pathway is worth attacking in follicular lymphoma when the antibody is a type II one.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-10-01
- Also known as: Zanubrutinib plus obinutuzumab in follicular lymphoma; ROSEWOOD trial
- Tags: lymphoma-evidence
- Registry id: NCT03332017
- Phase: 2
- Setting: Relapsed or refractory follicular lymphoma after two or more lines including an anti-CD20 antibody and an alkylating agent: zanubrutinib with obinutuzumab against obinutuzumab alone
- Sponsor: BeiGene
- Enrolled: 217
- Result: Overall response 69 against 46 per cent (p = 0.001) and median progression-free survival 28.0 against 10.4 months (hazard ratio 0.50).
- Outcomes: Overall response rate by independent central review: Zanubrutinib with obinutuzumab 69% vs Obinutuzumab alone 46%; Progression-free survival (median): Zanubrutinib with obinutuzumab 28 months vs Obinutuzumab alone 10.4 months, HR 0.5
- Replication: Not replicated; the comparator arm was obinutuzumab monotherapy rather than a combination in common use.

## Sources

- ClinicalTrials.gov NCT03332017: https://clinicaltrials.gov/study/NCT03332017
- Journal of Clinical Oncology 2023: https://doi.org/10.1200/JCO.23.00775

## Connected records

- 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/)
- technologies: [Monoclonal antibodies](https://onco.cc/technologies/monoclonal-antibody/)
- 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/)
- bottlenecks: [Too many combinations to test](https://onco.cc/bottlenecks/b-combination-space/)
- key papers: [ROSEWOOD: a phase II randomized study of zanubrutinib plus obinutuzumab versus obinutuzumab monotherapy in patients with relapsed or refractory follicular lymphoma](https://onco.cc/key-papers/paper-rosewood-zanubrutinib-obinutuzumab-follicular-jco-2023/)
- 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/)
- trials: [A Phase 3 Study to Assess Efficacy and Safety of Tafasitamab Plus Lenalidomide and Rituximab Compared to Placebo Plus Lenalidomide and Rituximab in Pa](https://onco.cc/trials/nct04680052/)

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