DENVER, CO – Since the first novel agent was approved for use in chronic lymphocytic leukemia patients in 2014, how have treatment regimens changed at the VHA?
That was the question behind a presentation at the recent 2020 American Society of Clinical Oncologists Annual Meeting.
Shift in the top 10 CLL treatments in the VHA over Five Fiscal Years
|
Treatment, N |
FY 2014 |
FY 2015 |
FY 2016 |
FY 2017 |
FY 2018 |
|
BR |
329 |
322 |
283 |
241 |
201 |
|
FR |
99 |
82 |
62 |
52 |
45 |
|
FCR |
77 |
66 |
58 |
48 |
41 |
|
CD20 (± novel agents or lenalidomide) |
534 |
521 |
461 |
395 |
334 |
|
Chlorambucil (−CD20) |
91 |
101 |
92 |
83 |
65 |
|
Chlorambucil (+CD20) |
43 |
64 |
63 |
61 |
44 |
|
Lenalidomide |
30 |
30 |
41 |
52 |
47 |
|
Ibrutinib |
228 |
554 |
893 |
1257 |
1603 |
|
Idelalisib |
3 |
46 |
54 |
46 |
49 |
|
Venetoclax |
0 |
0 |
11 |
45 |
127 |
© 2020 American Society of Clinical Oncology
A University of Colorado Denver-led study described the pharmacoepidemiology of three novel agents — ibrutinib, idelalisib, venetoclax — and traditional chemotherapies/chemoimmunotherapies (CT/CIT) in the VA healthcare system.
The retrospective study involved 26,879 CLL patients in the VHA from Oct. 1, 2013, to May 31, 2018, all of whom were followed for at least six months. Researchers extracted data from the VHA electronic health record.
Patients were from all 18 VISNs, including all 50 states and U.S. territories. Summarized were baseline characteristics, CLL treatments, next therapies, and secondary complications.
At least one of 12 CLL therapies of interest was received by 3,670 patients. Patients had a median age of 69 years — 47% were 65 and older, while 26% were 75 and older – with a median age-adjusted Charlson comorbidity score of 6. The authors reported that 6% had a history of exposure to Agent Orange.
Results indicated that ibrutinib accounted for 89% of the novel agent use. “Ibrutinib use across all lines of therapy (LOTs) increased sevenfold over the study period,” according to the report.
Venetoclax (42%) and idelalisib (30%) were most common for the next lines of therapies after ibrutinib. Across all lines of therapies, traditional chemotherapies/chemoimmunotherapies use declined steadily over the study period. Yet, in fiscal year (FY) 2018, 17% of patients were still receive those treatments. Ibrutinib was most common tor the next line of therapy in those patients (43–74%).
The study found that incidence of diffuse large B cell lymphoma post-index was two to six times higher in patients on chemotherapies/chemoimmunotherapies than those on ibrutinib. Other secondary complications were similar between ibrutinib and CT/CIT, they said.
“To our knowledge, this is the largest study looking at CLL treatment patterns among VHA patients in the real world,” the researchers wrote. “There has been a major shift in the treatment of CLL, with fast adoption of novel agents in the VHA from 2013 to 2018. The impact of this shift on healthcare resource use and cost burden in the VHA will need to be examined.”
1. Nooruddin Z, Le H, McHugh D, Ryan K, et. al. (2020, May 29-31.) The shift in therapies for the treatment of chronic lymphocytic leukemia (CLL) patients in the US Veterans Health Administration (VHA) from 2013-2018. ASCO20 Virtual Scientific Program.