Thanks to advances in research, there are now a lot of good treatment options for chronic lymphocytic leukemia (CLL). However, we still don’t know if the order that treatments are given matters or if there is an optimal treatment sequence that could improve patient outcomes.
Ibrutinib is a Bruton tyrosine kinase inhibitor that revolutionized CLL treatment by providing significant improvements in progression-free survival compared with chemotherapy and/or immunotherapy. Is the best time to use it early on in treatment? Or should it be used after other treatment options have failed?
At the annual meeting of the American Society of Hematology (ASH) 2019, our own Dr. Brian Koffman interviewed Dr. Paul Barr, an Associate Professor of Medicine at the Wilmot Cancer Institute, in Rochester, NY. They discussed a new analysis of clinical trial data that looks at how effective ibrutinib is depending on when it is used in a patient’s course of therapy.
Takeaways:
- Researchers went back to previously reported clinical trials of ibrutinib (RESONATE and RESONATE-2) and analyzed the data based on when ibrutinib was used in each patient’s course of therapy.
- Patients were grouped based on the number of therapies they received prior to ibrutinib (0, 1-2, or ≥3 therapies).
- 70% of patients who received ibrutinib as their first treatment (0 prior therapies), remained progression-free at 5 years.
- 60% of patients who received ibrutinib after 1-2 prior therapies, remained progression-free at 5 years.
- In contrast, only 33% of patients remained progression-free at 5 years when ibrutinib was used after three or more other therapies.
- Using ibrutinib as an earlier line of treatment resulted in better progression-free survival, overall survival, and response rate for patients with CLL, including patients with high-risk features.
- Ibrutinib was well tolerated with only 19% of patients across all lines of therapy discontinuing use due to adverse events.
Conclusions:
Using ibrutinib earlier in a patient’s course of treatment, (as a first therapy rather than a later therapy), improved tolerability and length of remission.
While this data shows that it is better to use ibrutinib early on in treatment, other researchers have also found that ibrutinib can still be effective for some patients even when it is used late in the course of treatment. See our previous interview with Dr. Jennifer Brown.
Please enjoy this brief interview with Dr. Barr from December 2019 at ASH in Orlando, FL.
You can read the actual abstract here: Using Ibrutinib in Earlier Lines of Treatment Results in Better Outcomes for Patients with Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
Take care of yourself first.
Ann Liu, PhD
