At the 2023 American Society of Clinical Oncology (ASCO) annual meeting in Chicago, Illinois, Kerry Anne Rogers, MD, Division of Hematology, The Ohio State University, Columbus, Ohio shared data on real-world dosing ibrutinib patterns and outcomes among patients with chronic lymphocytic leukemia (CLL). 

Transcript:

Hi, I'm Dr. Kerry Rogers. I'm an associate professor in the division of hematology at The Ohio State University, and I'm excited to share a little bit about our abstract, looking at real-world dosing patterns and outcomes with ibrutinib. 

We did this study, I did this in collaboration with Janssen real-world evidence, and it's been a very exciting collaboration to work with them and their team on some of this analysis. What we did was use an EMR database to try to get a handle on if dose reduction of ibrutinib impacted outcomes with ibrutinib. And, with real-world evidence, we use a time to next treatment to look at outcome, because of course, progression-free survival is very hard to determine from this type of data.

The exciting part is there was over 1,100 patients and we tried to capture first-line ibrutinib patients. Of course, the limitation is we just looked at patients that hadn't received other therapy in the prior 12 months, which could miss a few, but you are getting people newly on a BTK inhibitor, mostly first-line. The data collection was about 2016 to 2022, and we actually had 19.6%, which is about 1 out of 5 patients, that did have a dose reduction of ibrutinib while they were taking it. I think that's a robust number of patients to be able to look at differences.

The big message for me that I was excited about is that you did not see a difference in time to next treatment, suggesting that you don't lose the efficacy of ibrutinib by dose-reducing it. I would assume that, given that this is real world evidence, the dose reductions were toxicity, and not planned dose reductions for other reasons. 

The other thing that was really neat about this study is we were able to look at 2 different adherence measures with the data, and it looked like both adherence measures were actually higher in the patients that had a dose reduction than those that did not, which could potentially be due to better toxicity or other reasons, although we don't know in this type of study exactly why, given the nature of the data set.

I think for myself, I'm always excited about real-world evidence because it gets at things that we're not going to learn from a prospective trial and has different benefits that way, and also, obviously different drawbacks than prospective clinical trials. But I think this very much supports that in the clinic, dose reduction of ibrutinib for people on therapy will not increase the risk of not benefiting from that therapy, or decrease their expected benefit from doing that treatment. 

The increase in adherence is nice to see, that perhaps they're doing better with the therapy if this happens. I very much enjoyed this collaboration with Janssen real-world evidence, and I think this really supports that dose reduction with ibrutinib is feasible, and should not impact the patient outcomes negatively.

Source:

Rogers K A, Lu X, B Emond, et al. Real-world (RW) dosing patterns and outcomes among chronic lymphocytic leukemia (CLL) patients (pts) with or without an ibrutinib (IBR) dose adjustment (DA) in first-line (1L). Presented at ASCO Annual Meeting; June 2-6, 2023; Chicago, IL. Abstract 7637