At the ASH 2018 Annual Meeting, researchers used informCLL registry data to describe demographic and clinical characteristics of patients with chronic lymphocytic leukemia (CLL), as well as treatment patterns, dosing, and sequencing in clinical practice. The majority of practices reporting to the informCLL registry were community hematology-oncology sites. For this interim analysis, patients were grouped into 5 subsets by therapy: chemoimmunotherapy (CIT), chemotherapy, immunotherapy, ibrutinib, and other novel agents, including idelalisib and venetoclax. Eligible consenting patients were at least 18 years of age and had initiated a new line of treatment within 30 days of registry enrollment. A total of 840 patients were enrolled; 64% were male, median age was 70 years, and more than 85% had Eastern Cooperative Oncology Group performance scores of 0 or 1, denoting generally good overall health status.
In the 459 previously untreated patients, CIT was the most common treatment (42%), followed by single-agent ibrutinib (39%), bendamustine + rituximab (BR; 20%), fludarabine + cyclophosphamide + rituximab (FCR; 10%), and obinutuzumab + chlorambucil (GC; 9%). Among the 381 relapsed/refractory (R/R) patients, single-agent ibrutinib was the most common treatment (51%). In patients aged <65 years, CIT was the most common treatment in previously untreated patients (53%), and ibrutinib was the most common treatment in patients with R/R CLL (55%). In patients aged ≥65 years, ibrutinib was the most common treatment for previously untreated (43%) and R/R (49%) patients. Median follow-up was 9.4 months (range, 0-24.9).
Most patients receiving ibrutinib were started at a dose of 420 mg once daily. At time of analysis, 81% of ibrutinib patients did not require any dose modifications. Among previously untreated and R/R patients who received BR, 21% and 31%, respectively, were still receiving treatment at time of analysis. Among previously untreated and R/R patients who received GC, 23% and 50%, respectively, were still receiving treatment at time of analysis. Among previously untreated and R/R patients who received FCR, 22% and 33%, respectively, were still receiving treatment at time of analysis. Following enrollment, 114 of 840 (14%) patients received subsequent treatment. Ibrutinib was the most common subsequent treatment for previously untreated and R/R patients. In total, 43/114 (38%) patients subsequently received ibrutinib as a single agent or in combination.
In summary, most ibrutinib-treated patients started at the FDA-recommended, once-daily dose of 420 mg, with few dose interruptions or reductions. Conversely, most patients who received BR or FCR did not receive 6 cycles of treatment. Researchers intend to continue patient follow-up in their efforts to characterize real-world CLL treatment patterns.
Sharman J, et al. ASH 2018. Abstract 1872.