A group of researchers recently analyzed the evolution and adoption of therapy options for chronic lymphocytic leukemia (CLL) among community oncologists since 2020. Traditional therapy options for CLL have recently expanded to include second-generation Bruton tyrosine kinase inhibitors (BTKis) and b-cell 2 inhibitors (BCL2i). Current guidelines recommend these therapies to be used in first-line CLL treatment.

Jing-Zhou Hou, MD, University of Pittsburgh Medical Center, and colleagues used the Integra Connect PrecisionQ real-world deidentified database, which includes over 3 million cancer patients across 500 sites of care, to assess the first-line treatment of 6,328 patients with CLL from January 1, 2020, to June 30, 2023. The study found that BTKi therapy remains a popular therapeutic option, with its usage growing progressively from 55.8% in 2020 to 58.2% in 2022, and stabilizing around 56.3% in 2023. The second-generation BTKis have seen an impressive adoption rate, growing from 31.2% in 2020 to a substantial 80.7% of total BTKi usage in 2023. Additionally, BCL2i therapy saw a gradual increase from 14.6% in 2020 to 19.8% in 2023.

However, despite the advent and growing usage of these advanced therapies, nearly 20% of patients continued to receive chemotherapy as of the first half of 2023. The study also found that demographic and other clinical factors played a crucial role in therapy selection. For example, patients younger than 60 years old received BCL2i at a higher rate, while those 80 years and older were more likely to receive a BTKi. The rates of BTKi or BCL2i usage were higher among male patients and those without preexisting cardiac conditions. Importantly, patients who had been tested for either del17p or TP53 mutations received BTKi or BCL2i therapy more often.

According to the researchers, there is still a significant deviation in CLL therapy practice from the recommended guidelines. This deviation was more prevalent among female patients, patients ≥ 80 years old, patients with an ECOG of 2 or above, and patients without testing for del17p and TP53. These patients received BTKi and BCL2i therapy less frequently, suggesting a need for increased awareness about treatment guidelines and further research to understand these deviations.

While the adoption of second-generation BTKis and BCL2i as first-line CLL therapies has been growing among community oncologists, a significant proportion of patients still receive chemotherapy. This discrepancy, along with variations in treatment selection based on demographic and clinical factors, underscores the need for increased awareness and adherence to current CLL therapy guidelines. Further investigation into why such differences in treatment practices exist could help improve the quality of care delivered to CLL patients.

Hou JZ, Gart M, Vasudevan A, Katzen HI, Choksi R, Blanc S. Assessing adoption of standard of care and comparing clinical and demographic differences in first-line (1L) treatment (Tx) of chronic lymphocytic leukemia (CLL). Presented at: the 2023 ASH Annual Meeting & Exposition; December 9-12, 2023; San Diego, CA, and virtual; Abstract 130