OBJECTIVES : The most common regimen in the first-line DLBCL setting is rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP). The NCCN guidelines do not list a preferred regimen for relapsed/refractory (R/R) DLBCL. This highlights the need for new and effective treatments. The objective of this US claims analysis was to evaluate treatment patterns and overall cost.

METHODS : Adults diagnosed with DLBCL between January 2010 and June 2017 (index date) were identified using ICD-9/10 codes from Truven MarketScan. Patients were included if they had 1-year pre-index with no cancer diagnosis or treatment, and ≥6 months of post-index. Analyses were grouped by line of therapy 1 and 2 (LOT1 and LOT2).

RESULTS : There were 3,345 patients with mean follow-up of 6 years [standard deviation (SD) 2.3]. Median age was 61 years, with 56% male and 32% Medicare patients. Overall, 72% of patients were treated (LOT1 n=2,425) and of those 49% (LOT2 n=1182) relapsed. In LOT1, 1155 patients (48%) were treated with regimens listed within NCCN guidelines or other variations of RCHOP. In LOT2, only 333 patients (28%) were treated with a regimen listed within guidelines. There were 249 patients (10%) in LOT1 treated with rituximab-containing regimens not listed within guidelines; this number increased in LOT2 (16%). Use of only glucocorticosteroids was 38% in LOT1 and increased in LOT2 (52%). Stem-cell transplants (SCT) increased by LOT (3 and 10%, respectively). Mean total overall costs were highest in LOT1; LOT1=$117,048 (SD $87,457), LOT2=$87,771 (SD $90,269). Mean overall cost of SCT was highest in LOT1 [LOT1=$138,641 (SD $190,674), LOT2=$106,434 (SD $99,448).

CONCLUSIONS : Results highlight low adherence to NCCN guidelines in R/R DLBCL setting. Costs were highest in LOT1, though this may reflect longer duration of treatment. New treatments in R/R DLBCL are needed to meet the demands of a patient population with low adherence to treatment guidelines.