Type: Oral
Session: 902. Health Services and Quality Improvement – Lymphoid Malignancies: Making a Splash In Outcomes Data
Hematology Disease Topics & Pathways:
Lymphoid Leukemias, adult, Biological therapies, Clinical Practice (Health Services and Quality), CLL, Non-Biological therapies, Chemotherapy, Diversity, Equity, and Inclusion (DEI) , Diseases, Therapies, Lymphoid Malignancies, Human
Methods: Using the Integra Connect PrecisionQ real-world de-identified database of over 3 million cancer patients (pts) across 500 sites of care, we assessed 1L tx of 6,328 CLL pts between 1/1/2020 and 6/30/2023. For 1L CLL pts to be included, they must have had either >=5 CLL or small lymphocytic lymphoma (SLL) diagnosed visits, or more CLL or SLL visits than non-CLL or SLL visits if <5 CLL or SLL diagnosed visits. We measured 1L tx use of 1st gen BTKi, 2nd gen BTKi, BCL2i, anti-CD20 (aCD20), and chemotherapy (chemo). We also assessed how use might be impacted by gender, age, race, ECOG, testing for del17p and TP53, positivity for TP53 or del17p, and pre-existing cardiac conditions. A subset of pts was evaluated through manual chart review to assess for TP53 and del17p mutations (N = 1029). Descriptive analyses were used and proportions were compared using a two-tailed two sample z-test.
Results: Among the 6,328 CLL pts, the average age was 74.0 (median = 75), the gender distribution was 62.7% male, and 92.3% of pts had an ECOG of 0 or 1 at 1L. In calendar year 2020 (N = 1907), BTKi therapy accounted for 55.8% of 1L therapy, BCL2i accounted for 14.6%, aCD20 accounted for 9.8%, and chemo accounted for 19.8%. In 2020, the percentage of 1L pts treated with zanubrutinib was 0.2%, while acalabrutinib was 17.3% and ibrutinib was 38.4%; among BTKis, 2nd gen BTKi use was 31.2%. In calendar year 2022 (N = 1691), BTKi therapy accounted for 58.2% of 1L therapy, BCL2i accounted for 18.7%, aCD20 accounted for 4.0%, and chemo accounted for 19.0%, while 2nd gen BTKi use grew to 67.2% of total BTKi use. For January to June 2023 (N = 840), BTKi therapy accounted for 56.3% of 1L therapy, BCL2i accounted for 19.8%, aCD20 accounted for 5.2%, and chemo accounted for 18.6%. In 2023, the proportion of 1L pts treated with zanubrutinib was 14.7%, with acalabrutinib was 30.7%, and with ibrutinib was 10.8%; among BTKis, 2nd gen BTKi use increased to 80.7%.
Since 2020 among pts treated with a BTKi, no significant difference in 1L tx based on race was observed when comparing Black/African American pts (N = 177) treated with 2nd gen BTKis (48.0%) with white pts (N = 2271) treated with 2nd gen BTKis (54.5%) (p >.05). Of pts with pre-existing cardiac conditions (N = 988), 50.4% received a BTKi, whereas of those without known pre-existing cardiac conditions, 57.8% received a BTKi (N = 5340) (p <.001). Of pts who received a BTKi, those with pre-existing cardiac conditions received a 2nd gen BTKi at a rate of 60.4% (N = 502), while of those without pre-existing cardiac conditions (N = 3089), 52.9% received a 2nd gen BTKi (p <.001). Male pts received a higher rate of BTKi or BLC2i 1L tx (75.5%) than did female pts (70.8%) (p <.001). Pts age 60 and under (N = 630) received venetoclax at a rate of 26.3% compared to 11.6% of those age 80 and older (N = 2094) (p <.001). Pts age 60 and under received a BTKi at a rate of 48.9% compared to 59.6% of pts age 80 and older (p <.001). Among pts with a known ECOG, pts with an ECOG of <=1 (N = 4639) received a BTKi or BCL2i 76.2% of the time, compared to 71.4% of the time for pts with an ECOG of >=2 (N=388) (p <0.05). Among those pts evaluated via medical chart review, pts who had been tested for either del17p or TP53 (N = 855) received a BTKi or BCL2i 90.2% of the time, compared to 78.2% of those not tested (N = 174) (p < .001). Among pts with del17p or a TP53 mutation (N= 182), 70.3% received a BTKi, compared to 59.4% of those without del17p or a TP53 mutation (N = 217) (p <0.05).
Conclusion: The combined use of BCL2i and 2nd gen BTKis in 1L grew from 32.5% in 2020 to 65.2% in 2023 (2nd gen BTKi use among BTKis increased from 31.2% to 80.7%). However, in 2023, more than 33% of pts did not receive either of the recommended regimens per the guidelines; nearly 20% continue to receive chemo. We found that female pts, pts age 80 or older, pts with ECOG of >=2, and pts without testing for del17p and TP53 received BTKi therapy and BCL2i therapy less often. This suggests a need to increase awareness of the clinical guidelines for tx of CLL and further understand why such differences exist in the tx of CLL pts.
Disclosures: Hou: AbbVie: Consultancy; AstraZeneca: Consultancy; Genentech: Consultancy. Gart: Integra Connect: Current Employment. Vasudevan: IntegraConnect, Precision Q: Current Employment. Katzen: Integra Connect: Current Employment. Choksi: Integra Connect: Consultancy, Other: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events and support for attending meetings and/or travel . Blanc: IntegraConnect, Precision Q: Current Employment.