Study: Major Shift in the Treatment of Patients with CLL in the VHA

At the 2020 American Society of Clinical Oncology Virtual Scientific Program, researchers presented a recent study that is the largest to date analyzing chronic lymphocytic leukemia (CLL) treatment patterns among US Veterans Health Administration (VHA) patients between the years of 2013 and 2018. The objective of the study was to describe the pharmacoepidemiology of 3 novel agents (ibrutinib, idelalisib, venetoclax), and traditional chemotherapies/chemoimmunotherapies (CT/CIT) in the VHA.

Although the first novel agent for use with CLL was approved for use in 2014, the extent to which the novel agent had been adopted in the VHA was largely unknown. The findings from the study demonstrated that during the period between 2013 and 2018, there was a major shift in the treatment of CLL, with a fast adoption of novel agents in the VHA.

To investigate the issue, the researchers conducted a retrospective study of 26,879 adults with CLL in the VHA from October 1, 2013, to May 31, 2018. Participating patients came from all 18 Veterans Integrated Service Networks across all 50 states and US territories.

The researchers used extracted data from the VHA electronic health record and followed up with all patients for at least 6 months. Descriptive statistics also allowed the researchers to summarize baseline characteristics, CLL treatments, next therapies, and secondary complications for analysis.

In the study, 3670 patients out of the 26,879 patients total received at least 1 of 12 CLL therapies of interest. All of the patients had a median age of 69 years with a median age-adjusted Charlson comorbidity score of 6. Also, 6% had a history of exposure to Agent Orange.

Of the novel agent use, 89% was ibrutinib, and its use across all lines of therapy (LOTs) increased sevenfold during the study period. For the next LOT after ibrutinib, venetoclax (42%) and idelalisib (30%) were the most common therapies.

Across all LOTs, traditional CT/CIT use declined during the study period. However, there were still 17% of patients receiving CT/CIT by 2018.

For the next LOT, ibrutinib (43%—74%) was the most common therapy. Incidence of diffuse large B cell lymphoma post-index was 2 to 6 times greater in patients on CT/CIT than those on ibrutinib, while other secondary complications were similar between ibrutinib and CT/CIT.

Although the results of the study demonstrated a clear shift in novel treatment adoption at the VHA for patients with CLL, the researchers noted that the impact of this shift on health care resource use and cost burden in the VHA needs further examination.

REFERENCE

Nooruddin Z, Le H, McHugh D, et al. The shift in therapies for the treatment of chronic lymphocytic leukemia (CLL) patients in the US Veterans Health Administration (VHA) from 2013-2018 [ASCO abtract e19339]. 2020 ASCO Virtual Scientific Program. 2020;38(suppl). doi: 10.1200/JCO.2020.38.15_suppl.e19339.