Real-World Treatment Patterns of First-Line (1L) Ibrutinib in Chronic Lymphocytic Leukemia/ Small Lymphocytic Lymphoma (CLL/SLL): Insights into Therapy Interruptions, Discontinuation and Next Treatment
Author(s)
John Burke, MD1, Ira Zackon, MD2, Brittani Wayne, MPH2, Yunfei Wang, PhD MPH2, John Murphy, MS2, Jennifer Prescott, PhD3, Shravanthi R Gandra, PhD, MBA3, Siyang Leng, MD3, Enrico De Nigris, MS4.
1Rocky Mountain Cancer Centers, Aurora, CO, USA, 2Ontada, Boston, MA, USA, 3Merck & Co., Inc., Rahway, NJ, USA, 4MSD (UK) Limited, London, United Kingdom.
1Rocky Mountain Cancer Centers, Aurora, CO, USA, 2Ontada, Boston, MA, USA, 3Merck & Co., Inc., Rahway, NJ, USA, 4MSD (UK) Limited, London, United Kingdom.
OBJECTIVES: Given the evolving treatment landscape and continued reliance on ibrutinib despite availability of newer targeted therapies, this real-world study aimed to characterize treatment patterns in CLL/SLL patients who began first-line (1L) ibrutinib-based regimens between 11/21/2019 and 7/31/2023 in The US Oncology Network.
METHODS: Data were captured from the iKnowMed electronic health record through 7/31/2023. All analyses were descriptive, and index was the date of 1L ibrutinib initiation.
RESULTS: The study included 384 patients, classified based on treatment sequencing patterns into the following subsets: 1) second-line (2L) non-BTKi (n=34), 2) ibrutinib retreatment after a toxicity hold (n=55), 3) 2L second-generation (2G) BTKi (n=47), and 4) no subsequent treatment (n=248). The median follow-up duration was 25.6 months (IQR: 16.2, 35.2). The median age was 74 (IQR: 66, 80), and 37.2% (n=143) were female. The median time from diagnosis to index was 23.9 months (IQR: 4.1, 60.6). A total of 177 patients (46.1%) in the overall population interrupted ibrutinib treatment for any reason, with 64.4% (n=114) doing so due to adverse events (AEs). The median time to interruption of 3.9 months (IQR: 1.3, 11.3). Notably, 91.2% (n=352) of the patients permanently discontinued ibrutinib, with a median time to ibrutinib discontinuation of 14.5 months (IQR: 5.3, 27.4). Additionally, 78.9% (n=303) did not initiate a 2L regimen during the study period. AEs were the primary reason for discontinuation in 32.4% (n=114) of patients, while disease progression (PD) accounted for 4.3% (n=15). Among 81 patients who started 2L treatment, 48.1% (n=39) of patients initiated acalabrutinib-based regimens.
CONCLUSIONS: This study highlights the challenges in managing patients with CLL/SLL undergoing 1L ibrutinib therapy, noting high rates of treatment interruptions and discontinuations, frequently due to AEs. These findings underscore the need for innovative targeted therapies in CLL aimed at improving patient outcomes and their quality of life.
METHODS: Data were captured from the iKnowMed electronic health record through 7/31/2023. All analyses were descriptive, and index was the date of 1L ibrutinib initiation.
RESULTS: The study included 384 patients, classified based on treatment sequencing patterns into the following subsets: 1) second-line (2L) non-BTKi (n=34), 2) ibrutinib retreatment after a toxicity hold (n=55), 3) 2L second-generation (2G) BTKi (n=47), and 4) no subsequent treatment (n=248). The median follow-up duration was 25.6 months (IQR: 16.2, 35.2). The median age was 74 (IQR: 66, 80), and 37.2% (n=143) were female. The median time from diagnosis to index was 23.9 months (IQR: 4.1, 60.6). A total of 177 patients (46.1%) in the overall population interrupted ibrutinib treatment for any reason, with 64.4% (n=114) doing so due to adverse events (AEs). The median time to interruption of 3.9 months (IQR: 1.3, 11.3). Notably, 91.2% (n=352) of the patients permanently discontinued ibrutinib, with a median time to ibrutinib discontinuation of 14.5 months (IQR: 5.3, 27.4). Additionally, 78.9% (n=303) did not initiate a 2L regimen during the study period. AEs were the primary reason for discontinuation in 32.4% (n=114) of patients, while disease progression (PD) accounted for 4.3% (n=15). Among 81 patients who started 2L treatment, 48.1% (n=39) of patients initiated acalabrutinib-based regimens.
CONCLUSIONS: This study highlights the challenges in managing patients with CLL/SLL undergoing 1L ibrutinib therapy, noting high rates of treatment interruptions and discontinuations, frequently due to AEs. These findings underscore the need for innovative targeted therapies in CLL aimed at improving patient outcomes and their quality of life.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
RWD137
Topic
Real World Data & Information Systems
Topic Subcategory
Distributed Data & Research Networks
Disease
SDC: Oncology