Kerry Rogers, MD, The Ohio State University, Columbus, OH, discusses real-world treatment costs of tumor lysis syndrome among patients with chronic lymphocytic leukemia (CLL) and small lymphocytic leukemia (SLL).

This study was presented at the virtual 2021 ASH Annual Meeting in Atlanta, GA.

Transcript:

I'm Kerry Rogers. I'm an assistant professor in the Division of Hematology at the Ohio State University. I'm going to talk to you today about a really cool project that's a collaboration with Janssen. It's looking at real-world data regarding the cost of tumor lysis syndrome in patients with CLL and SLL.

Tumor lysis syndrome is a condition where cancer cells break down rapidly and release toxins into the blood, electrolytes, and uric acid. This can be very dangerous for patients and requires very intensive management. Patients can even need short-term dialysis for this. It's something that happens frequently in blood cancers when you start treatment.

In CLL and SLL particularly, there are several therapies that have a risk of tumor lysis syndrome that's considered high as per guidelines, including chemoimmunotherapy, which these days is used less and less. Those definitely have this risk.

Lenalidomide, obinutuzumab, and venetoclax. Venetoclax is a more recently approved drug that can be given in fixed-duration regimens for CLL and SLL and requires a very defined tumor lysis syndrome mitigation and monitoring strategy when you start the drug. It's very relevant to this newer therapy.

In this study we used claims data going back as far as January 1st of 2006 and identified patients who received one of those regimens I mentioned that have a high risk for tumor lysis and reviewed events of tumor lysis syndrome, whether or not they occurred in the first 90 days after starting the regimen.

It was considered treatment-emergent if it occurred in the first 90 days after starting the therapy. Overall, in this study it included thousands of patients. Only 1.1%, which was a relatively low fraction, actually developed tumor lysis syndrome. One of the really important findings was that patients who developed tumor lysis syndrome had higher costs associated with their care.

The way we looked at this was we divided the time period into 30-day segments. In patients who did not develop tumor lysis syndrome, all of those were considered non-TLS or non-tumor-lysis-syndrome segments. In patients who did develop tumor lysis syndrome, time that occurred before they developed it was considered non-TLS.

Then every time period after they developed TLS was considered as a tumor-lysis-syndrome segment. You do have some segments that are after the event of tumor lysis syndrome that are included there.

Overall, patients who experienced tumor lysis syndrome had a higher cost associated with their care, which is an expected finding because those patients really need intensive treatment.

On average, those costs were $3,062 per month more. That was largely driven by in-patient costs. Those patients were usually admitted for management.

What is also relevant to this study is that, as I mentioned, venetoclax has this tumor lysis syndrome mitigation and monitoring strategy that's very important to safely utilize this drug and is in the full prescribing recommendations for venetoclax.

That did have a higher cost associated with starting it. However, patients with venetoclax who developed tumor lysis syndrome had a higher cost than patients who did not have tumor lysis syndrome. Using this strategy is still worthwhile, not only from a safety-and-patient-care perspective, but also from a financial perspective because developing tumor lysis syndrome does increase healthcare costs with these venetoclax regimens. I will point out that the majority of patients in this analysis were treated with chemoimmunotherapy, so it was a smaller fraction that were venetoclax-treated. That's really an important finding.

Overall, I would say that this data is expected. We know that tumor lysis syndrome is costly to manage and really does point out that mitigation strategies are important. Even though it might have more healthcare costs associated with monitoring, actually developing tumor lysis syndrome is, again, not only very bad for patient care but also can be quite costly.

Venetoclax is just an outstanding drug for CLL that is more recently in use. There's been a lot of discussion around tumor lysis syndrome relating to venetoclax more recently and also strategies to reduce this risk of tumor lysis syndrome. Just knowing with real-world evidence that this is the case, it's going to be really relevant for people that are choosing to use drugs like venetoclax.

Also, just knowing that there's higher healthcare costs associated with using regimens at high risk for tumor lysis syndrome like venetoclax, that has to be taken into account when having a risk-benefit discussion with patients about their different treatment options for chronic lymphocytic leukemia or small lymphocytic lymphoma, which is the lymphoma equivalent of CLL.

CLL is the most prevalent leukemia in adults. This has a really big impact on our healthcare system in the United States. I want to thank everyone for listening in on what I had to say about our work. I also want to thank Janssen for our continued collaboration.

Dr. Rogers received research funding from Genentech, AbbVie, and Janssen and participated in an advisor boards for Acerta Pharma, Genentech, AbbVie, Innate Pharma, AstraZeneca, Pharmacyclics, and Beigene.