Authored by Dr. Brian Koffman
The Bottom Line:
More research is presented again, proving that targeted therapies, in this case, ibrutinib, are significantly superior to chemoimmunotherapy (CIT) in front-line therapy for patients with chronic lymphocytic leukemia or small lymphocytic lymphoma (CLL / SLL). What distinguishes this study is that it used an extensive database of real-world insurance claims.
Who Performed the Research and Where Was it Presented:
Ruibin Wang of Janssen Scientific Affairs led a group of investigators that presented their results at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago in 2023.
Over the past five years and longer, there has been plenty of research, including these practice-changing clinical trials such as Alliance A041202 and ECOG-ACRIN, that demonstrated the dramatic superiority of ibrutinib over CIT when used as first-line treatment in CLL / SLL. It is now that it is no longer ethical to use CIT as a comparator to ibrutinib or any target agents, as there is no equipoise in such trials.
Methods and Participants:
This vast retrospective study evaluated treatment outcomes among patients with CLL / SLL treated first-line with either ibrutinib or CIT using the US insurance claims data from a large payer dataset derived from >150 private insurers and >140 million insured individuals from 2015 to 2022.
- A total of 3570 first-line ibrutinib and 2391 CIT-treated patients were included.
- The mean age was 68 vs. 64 years, 63% female vs. 66% male.
- Median follow-up was 26 vs 31 months.
- 13% versus 26% of patients recorded a next treatment during the study period for ibrutinib and CIT, respectively.
- At 1, 3, and 5 years post-index, the probabilities of not initiating a new treatment were 92%, 83%, and 76% for the ibrutinib cohort versus 88%,70%, and 56% for the CIT cohort, respectively.
- After controlling for baseline characteristics, first-line ibrutinib patients were almost 40% less likely to initiate the next line of therapy during the study period (hazard ratio 0.61).
Once again, we learn that front-line single-agent ibrutinib was associated with a significantly lower risk of advancing to the next treatment line than CIT in this large claims-based data set. While the difference is dramatic, and it is reassuring to see that the results are consistent across a vast real-world database, we no longer need to prove the superiority of target agents such as ibrutinib. It’s already proven. Thankfully more research is now moving on to study the best way to combine and sequence these revolutionary therapies. We need more research comparing the different target therapies to each other, not more comparing to CIT.
Links and Resources:
Watch my monologue on the ASCO abstract:
To read more details in the ASCO abstract, click on Real-world treatment outcomes in patients with chronic lymphocytic leukemia or small lymphocytic lymphoma who were treated with first-line single-agent ibrutinib vs. chemoimmunotherapy.
Stay strong. We are all in this together.
Brian Koffman MDCM (retired) MS Ed (he, him, his)
Co-Founder, Executive VP, and Chief Medical Officer
CLL Society, Inc.