Ibrutinib may improve progression-free survival (PFS) for patients with chronic lymphocytic leukemia (CLL) if the full dose is taken on schedule, according to results extracted from clinical trial data and presented at the Oncology Nursing Society Annual Congress (April 28-May 1, 2016; San Antonio, Texas).
The convenience of oral anticancer therapies such as ibrutinib make them an attractive option for patients and prescribing doctors, but they can also be far more difficult to monitor, making it easier for patients to not adhere to treatment schedules.
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Looking at data from the RESONATE clinical trial, researchers led by Sarah Deisinger, RN, BSN, evaluated the effects of ibrutinib dose intensity and dose interruptions due to adverse events on PFS in 195 patients with relapsed or refractory CLL compared with ofatumumab.
Deisinger and colleagues defined dose intensity as the ratio between administered ibrutinib to the planned 420-mg daily dose of ibrutinib all patients were started on regardless of weight, age, or comorbidities.
After a median 8.6 months follow-up, mean ibrutinib dose intensity was 95%. The researchers observed that, in patients with a dose intensity above 95%, progression was not reached, whereas, in patients whose dose intensity was below 95%, median PFS was 6.9 months.
A total of 76 patients had interruptions in their treatment, 73 of whom (92%) later restarted treatment at standard protocol dosage. A total of 57 patients had dose interruptions of at least 8 consecutive days. Patients who missed fewer than 8 days of ibrutinib treatment (n = 137) had longer median PFS than those who missed more than 8 days of treatment (not reached vs 10.9 months).
Thus, researchers concluded that a higher mean ibrutinib dose with fewer interruptions may lead to improved PFS in patients with CLL. Oncology nurses should work towards providing patients with adequate resources to ensure they understand the importance of adhering to the full dosage of ibrutinib.
“It is imperative to educate our patients on the clinical importance of sustained adherence to the continuous once-daily dose of 420 mg in patients with previously treated CLL,” Deisinger concluded. “Because oral chemotherapy typically means fewer doctor visits, it is essential that oncology providers and nurses develop strategies to educate, assess and document oral adherence in their patients who will be administering their chemotherapy pills independently.”
