Real-world characteristics, treatment patterns, and outcomes of patients with 2 or more LOTs for CLL/SLL in the United States

Matthew S. Davids , Jacob Ambrose , Enrico de Nigris , Jennifer Prescott , Siyang Leng , Mohammed Z. H. Farooqui , Shravanthi R. Gandra , Christina M. Zettler , Laura L. Fernandes , Ching Kun Wang , Mazyar Shadman
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Abstract

The development of targeted agents for chronic lymphocytic leukemia (CLL) has transformed the treatment paradigm for patients with CLL. Because of this evolving treatment landscape, contemporaneous evidence was needed related to US treatment patterns and outcomes among patients treated in the real-world. Using COTA’s electronic health records–based database, we examined characteristics, treatment patterns, and outcomes of patients receiving ≥2 lines of therapy (LOTs). A total of 1283 adult patients with CLL were identified who initiated second LOT (2L) between 1 January 2014 and 30 June 2022. Of those patients, 542 (42.2%) later received third-line (3L) therapy, of whom 228 (42.1%) went on to receive fourth-line (4L) therapy. Overall, >18% of patients died after 2L initiation and before 3L initiation, and more than a quarter died before 4L initiation. Most patients were White (77.7%), male (60.6%), aged ≥65 years (68.8%), and treated in a community practice setting (87.8%). From 2014 to 2023, the use of chemoimmunotherapy in any ≥2L LOT decreased, whereas use of Bruton tyrosine kinase inhibitor and B-cell lymphoma 2 inhibitor therapy increased. Across endpoints, median times to event(s) were generally shorter with each subsequent LOT received, both in the overall population and among patients receiving a given therapy in different LOTs. With a median follow-up time from 2L initiation of 38.0 months, median real-world time to next treatment, progression-free survival, and overall survival was 31.9, 33.8, and 80.1 months, respectively. Despite great advancements in CLL treatments since 2014, unmet need persists for patients receiving late LOT.
在美国,有2个或更多lot的CLL/SLL患者的真实世界特征、治疗模式和结果
摘要慢性淋巴细胞白血病(CLL)靶向药物的发展改变了慢性淋巴细胞白血病(CLL)患者的治疗模式。由于这种不断发展的治疗前景,需要与美国治疗模式和现实世界治疗患者结果相关的同期证据。使用COTA基于电子健康记录的数据库,我们检查了接受≥2线治疗(lot)的患者的特征、治疗模式和结果。共有1283名成年CLL患者在2014年1月1日至2022年6月30日期间接受了第二次LOT (2L)治疗。在这些患者中,542例(42.2%)后来接受了三线(3L)治疗,其中228例(42.1%)继续接受了四线(4L)治疗。总体而言,18%的患者在2L起始后和3L起始前死亡,超过四分之一的患者在4L起始前死亡。大多数患者为白人(77.7%),男性(60.6%),年龄≥65岁(68.8%),在社区实践环境中接受治疗(87.8%)。从2014年到2023年,化疗免疫治疗在任何≥2L LOT中的使用减少,而布鲁顿酪氨酸激酶抑制剂和b细胞淋巴瘤2抑制剂治疗的使用增加。在各个终点,无论是在总体人群中还是在不同批次中接受给定治疗的患者中,每次接受LOT治疗,到事件发生的中位时间通常都更短。从2L开始的中位随访时间为38.0个月,到下一次治疗的中位真实时间、无进展生存期和总生存期分别为31.9个月、33.8个月和80.1个月。尽管自2014年以来CLL治疗取得了巨大进展,但晚期LOT患者的需求仍未得到满足。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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