Bruton tyrosine kinase inhibitor (BTKi) therapies, approved for relapsed or refractory (R/R) mantle cell lymphoma (MCL), have not been comprehensively evaluated in real-world populations. A study presented at the 2022 ASCO Annual meeting aimed to assess patient characteristics, treatment patterns, and associated outcomes in real-world BTKi-treated patients with MCL.

Bijal D Shah MD, MS, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, and colleagues conducted retrospective multicenter chart in the Cardinal Health Oncology Provider Extended Network. EMR data were extracted for eligible patients diagnosed with MCL who initiated any of the approved BTKi (ibrutinib [ibr], acalabrutinib [acal], zanubrutinib [zanu]) from 2018 to 2021; patients who were enrolled in trials were excluded. Index date was defined as the use of any of the BTKis. Patients were followed 12-mo pre-index for medical history, and from index to last follow-up or death. Descriptive analyses were conducted to assess demographic/clinical characteristics, MCL baseline features, BTKi treatment patterns, adverse events (AE), and response rates by BTKi. Multivariable logistic regression was performed to assess factors associated with response and AE.

The study cohort consisted of 300 patients with MCL (59% male; 69% white. BTKis were given mainly as monotherapy (93%) and in R/R setting (86%). Patients in zanu group were significantly older (n = 100, median age = 71 years, range = 50-91) when compared with patients in ibr (n = 100, median age = 69 years, range = 39-87) and acal (n = 100, median age = 70 years, range = 51-86) groups. Significantly fewer patients in the zanu group had baseline Ann Arbor stage I-II (4%) when compared with ibr (10%) or acal (13%), while more zanu patients had presence of B symptoms (67%) than ibr (44%) or acal (57%). Patients in the zanu group also had significantly less with ECOG of 3+ (4%) compared to ibr (8%) or acal (6%). At BTKi initiation, significantly more patients in zanu group (18%) had history of atrial fibrillation than ibr (1%) or acal (5%). Multivariable regression reported a significant association of age, gender, extranodal/splenic involvement, and timing of BTKi initiation with response and AE.

“This study provides the first RW evidence on comparative effectiveness of ibr, acal, zanu in MCL patients,” wrote Bijal D Shah MD, MS, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, and colleagues. “While patients treated with zanu were older and had more complex MCL baseline features at initiation, multivariable regression suggested a trend favoring zanu over ibr or acal for both response and AE. Frontline initiation of BTKi therapy was also associated with improved tolerability. Future RW studies are needed to discern long-term outcomes.”

Source:

Shah BD, Yang K, Klink AJ, et al. Real-world (RW) treatment patterns and comparative effectiveness of Bruton tyrosine kinase inhibitors (BTKi) in patients (pts) with mantle cell lymphoma (MCL). Abstract presented at: ASCO Annual Meeting; June 3-7, 2022; Chicago, IL, and virtual. Abstract e18727.