Real-world treatment patterns and characteristics in patients with chronic lymphocytic leukemia.

65 Background: CLL is the most prevalent form of adult leukemia. In recent years, there have been a number of newly approved therapies for the management of patients with CLL in both the 1st line (1L) and relapsed/refractory settings, including ibrutinib (approved for 1L CLL, March 2016). Methods: USphysicians involved in CLL treatment decision-making were recruited into the Adelphi CLL Disease Specific Programme (February-May 2016). Physicians completed record forms on consecutively presenting patients > 18 years currently on active CLL treatment. Descriptive statistics analyzed demographics, clinical characteristics, and antineoplastic treatment patterns. Results: 700 patients diagnosed with CLL for an average of 3.0 years were captured. Patients’ mean age was 68.3 years, 53% were male, 75% were Caucasian, 25% had 17p deletion, and 55% were Medicare insured. Of the 81 physicians, 35% were based in an academic hospital setting, 51% in a non-academic hospital setting, 4% in both, and 9% were office-based. Within the overall cohort, BR was the most common 1L regimen (25%), while ibrutinib was the most common 2nd line (2L) regimen (42%). Among patients with 17p deletion, BR was the most common 1L regimen (25%) and ibrutinib was the most common 2L regimen (50%). Older patients ( ≥ 65) were most likely to receive BR at 1L (28%), while 1L younger patients ( < 65) received FCR (24%). Conclusions: This analysis of real world treatment patterns identified BR, FCR, and ibrutinib as the most common 1L regimens in US CLL patients. Ibrutinib, BR, and idelalisib + rituximab were the most common 2L regimens. Choice of therapy varied depending on age and 17p deletion status. For example, FCR was more frequently used as 1L therapy in patients < 65 years, and the proportion of ibrutinib use as 1L therapy was higher in those with 17p deletion. [Table: see text]

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Real-world testing and treatment patterns in chronic lymphocytic leukemia: A SEER patterns of care analysis

Cancer ◽

10.1002/cncr.31738 ◽

2018 ◽

Vol 125 (1) ◽

pp. 135-143 ◽

Cited By ~ 10

Author(s):

Erlene K. Seymour ◽

Julie J. Ruterbusch ◽

Jennifer L. Beebe-Dimmer ◽

Charles A. Schiffer

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Real World ◽

Treatment Patterns ◽

Lymphocytic Leukemia ◽

Patterns Of Care

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Analyzing treatment patterns and time to the next treatment in chronic lymphocytic leukemia real-world data using automated temporal phenotyping.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e19512 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e19512-e19512

Author(s):

Kyeryoung Lee ◽

Zongzhi Liu ◽

Meng Ma ◽

Yun Mai ◽

Christopher Gilman ◽

...

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Real World ◽

Clinical Decision Making ◽

Single Agent ◽

Treatment Patterns ◽

Lymphocytic Leukemia ◽

Time Interval ◽

Real World Data ◽

World Data ◽

Therapeutic Class

e19512 Background: Targeted therapy is an important treatment for chronic lymphocytic leukemia (CLL). However, optimal strategies for deploying small molecule inhibitors or antibody therapies in the real world are not well understood, largely due to a lack of outcomes data. We implemented a novel temporal phenotyping algorithm pipeline to derive lines of therapy (LOT) and disease progression in CLL patients. Here, the CLL treatment pattern and time to the next treatment (TTNT) were analyzed in real-world data (RWD) using patient electronic health records. Methods: We identified a CLL cohort with LOT from the Mount Sinai Data Warehouse (2003-2020). Each LOT consisted of either a single agent or combinations defined by NCCN CLL guidelines. We developed a natural language processing (NLP)-based temporal phenotyping approach to automatically identify the number of lines and therapeutic regimens. The sequence of treatment and time interval for each patient were derived from the systematic treatment data. Time to event analysis and multivariate (i.e., age, gender, race, other treatment patterns) Cox proportional hazard (CoxPH) models were used to analyze the patterns and predictors of TTNT. Results: Four hundred eleven CLL patients received 1 to 7 LOTs. Ibrutinib was the predominant 1st LOT (40.8% of patients) followed by anti-CD20-based antibody therapies and chemotherapy in 30.6 and 19.2% of patients, respectively, followed by Acalabrutinib, Venetoclax, and Idelalisib in 3.4, 2.7, and 0.7% of patients, respectively (Table 1). The 2nd to 5th LOT showed the same or similar trends. We next analyzed the TTNT in the 1st line of each therapeutic class. Acalabrutinib resulted in a longer median TTNT than Ibrutinib. Both Acalabrutinib and Ibrutinib showed longer TTNT compared to Venetoclax (median TTNTs were 742 and 598 vs. 373 days: HR = 0.23, p=0.015 and HR = 0.48, p=0.03, respectively). In addition, patients with age equal to or older than 65 showed longer TNNT (HR=0.16, p=0.016). Conclusions: Our result shows the potential of RWD usage in clinical decision making as real-world evidence reported here is consistent with results derived from clinical trial data. Linking this study to genetic data and other covariates affecting treatment outcomes may provide additional insights into the optimal sequences of the targeted therapies in CLL. Table 1: Therapeutic class and patient numbers (%) in each line.[Table: see text]

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Patterns and predictors of treatment in muscle-invasive bladder cancer (MIBC): A real-world study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e16531 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e16531-e16531

Author(s):

Zengqi Lu ◽

Jessica M. Clement ◽

Qi Pan ◽

Helen Swede ◽

Rajni Mehta ◽

...

Keyword(s):

Logistic Regression ◽

Real World ◽

Alternative Treatment ◽

Standard Care ◽

Strong Predictor ◽

Treatment Patterns ◽

Cancer Center ◽

Data Set ◽

Adoption Rate ◽

To Receive

e16531 Background: Among the approaches to curative-intent therapy for MIBC, neoadjuvant cisplatin-based chemotherapy (NAC) is recognized as the gold standard. The combined modality approach of concurrent chemo-radiation is also considered a standard of care. Despite guidelines recommending multidisciplinary care, studies have shown a low adoption rate of multidisciplinary approaches for MIBC. This study aimed to describe the treatment patterns for MIBC pts using real world data. Methods: Following the appropriate IRB approvals, investigators followed a common protocol under the auspices of the Rapid Case Ascertainment at the Yale Cancer Center. Manual chart review was performed on MIBC pts diagnosed in Connecticut from 2004 –2015 and treated at investigator-affiliated hospitals. Information on medical history, comorbidity, and treatment types were recorded. This data set was linked to the Surveillance, Epidemiology, and End Results (SEER) database for demographic information. The descriptive and logistic regression were used to analyze treatment patterns and predicators in each treatment lines: surgery alone, chemotherapy alone, radiation alone and standard care (NAC followed by surgery; surgery followed by adjuvant chemotherapy and concurrent chemo-radiation). Results: The number of adult MIBC pts in the cohort was 1,198. Among them, 290 (24.2%) received surgery as the only treatment; 117 (9.8%) received chemotherapy only; 100 (8.3%) received concurrent chemo-radiation; 96 (8.0%) received NAC followed by surgery. Besides age ( OR: 0.546, 95% CI: 0.289-0.986), when comparing female to male patients on the likelihood of receiving NAC to the alternative treatment types (radiation or surgery), female pts were less likely to receive NAC than males (OR: 0.421, 95% CI: 0.184-0.930). Conclusions: Regardless of demographics, the overall adoption rate of standard care was low, consisting of 236 pts (19.7%) of the population. From the logistic regression results, age was consistently shown as a predictor for receiving NAC over the alternative treatment types, and sex was identified as another strong predictor. Older and female patients were less likely to receive NAC than younger males.[Table: see text]

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Real-world treatment patterns in first line and relapsed Chronic Lymphocytic Leukemia (CLL)

Clinical Lymphoma Myeloma & Leukemia ◽

10.1016/j.clml.2015.04.065 ◽

2015 ◽

Vol 15 ◽

pp. S204-S205 ◽

Cited By ~ 1

Author(s):

Bruce Feinberg ◽

Brad Schenkel ◽

Ali McBride ◽

Lorie Ellis ◽

Janna Radtchenko

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Real World ◽

Treatment Patterns ◽

Lymphocytic Leukemia ◽

First Line

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Real-world concordance of clinical practice with ASCO and NCCN guidelines for EGFR/ALK testing in aNSCLC.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.212 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 212-212 ◽

Cited By ~ 8

Author(s):

John E. Ruggiero ◽

Jay Rughani ◽

Josh Neiman ◽

Steven Swanson ◽

Cindy Revol ◽

...

Keyword(s):

Clinical Oncology ◽

Real World ◽

Treatment Decision ◽

Disease Diagnosis ◽

First Line ◽

Nccn Guidelines ◽

Treatment Decision Making ◽

First Line Therapy ◽

Line Therapy ◽

Biomarker Testing

212 Background: Timely and appropriate biomarker testing guides evidence-based treatment decision-making in advanced non-small cell lung cancer (aNSCLC). American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines recommend that all treatment-eligible patients with non-squamous, or squamous histology in non-smokers undergo EGFR and ALK biomarker testing prior to initiating first line therapy. Genentech’s Learning and Clinical Integration team and Flatiron Health explored the frequency of EGFR/ALK testing and overall time between advanced disease diagnosis, results receipt and treatment initiation in clinical oncology practices. Methods: Structured and unstructured data were obtained from Flatiron’s electronic health record database. 6,991 patients from 166 clinics diagnosed after 1/1/14 with at least 2 visits before 8/31/15 were randomly selected from the Flatiron aNSCLC national cohort of > 25,000 patients. Dates of specimen collection, results receipt and treatment start were collected. Results: EGFR/ALK testing was conducted in 75% of non-squamous patients with wide variation across practices (< 20% to 100%). For squamous patients, 15% were tested overall, but with dramatic variation across practices (0% to 100%). For patients with a positive test result available prior to initiation of first line treatment, 79% of EGFR+ and 94% of ALK+ patients received the appropriate targeted therapy. However, for those patients tested after initiation of first line therapy, only 41% of EGFR+ and 65% of ALK+ patients received appropriate targeted first line therapy. EGFR/ALK tests results were received > 4 weeks from aNSCLC diagnosis in 32% and 34% of patients, respectively. Validation testing indicated that delays were attributed to non-lab factors, as test results were returned in < 2 weeks in 95% of cases. Conclusions: Wide variation in real-world practice illustrates the need to improve adherence to ASCO and NCCN biomarker testing guidelines. Educational intervention to improve quality of care in aNSCLC should focus on ensuring testing of almost all non-squamous patients, limiting testing to the non-smoking squamous cell population, and ensuring timely ordering of testing by clinicians.

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Racial disparities in radium-223 treatment in a large real-world population.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.268 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 268-268

Author(s):

Hanson Hanqing Zhao ◽

Lauren Howard ◽

Amanda de Hoedt ◽

Martha K Terris ◽

Christopher L. Amling ◽

...

Keyword(s):

Prostate Cancer ◽

Black Men ◽

Real World ◽

Multivariable Analysis ◽

Treatment Patterns ◽

World Population ◽

Castration Resistant Prostate Cancer ◽

Cox Models ◽

Radium 223 ◽

To Receive

268 Background: Black men with prostate cancer are more likely to have unfavorable tumor characteristics and are at greater risk of prostate cancer mortality. Radium-223 is a FDA approved treatment for metastatic castration-resistant prostate cancer (mCRPC) that showed a survival benefit in the ALSYMPCA trial, where 94% of the participants were Caucasian. We aim to examine treatment patterns and outcomes of radium-223 in a large, heterogeneous population in the real world. Methods: We reviewed charts of all men with diagnosed with mCRPC in the entire Veterans Affairs (VA) system alive as of January 1st, 2013 who received radium-223. We compared common treatment patterns and characteristics between black and nonblack men. We analyzed predictors of time from radium-223 start to overall survival and time to skeletal related event (SRE) with Cox models. Results: 318 patients with bone mCRPC who received radium-223 were identified. 27% (87/318) were black. Black men were younger (67 vs 70 years, p = 0.001) and had higher PSA and alkaline phosphatase (ALP) levels at radium start (p = 0.014 and 0.017, respectively). There were no significant differences in biopsy Gleason, number of bone metastasis, primary localized treatment (yes/no), PSA doubling time, bone pain, or number of radium injections. Black men had lower mortality risk (HR 0.75; 95% CI 0.57 to 0.98; P = 0.038) on multivariable analysis. Comparison of common treatment patterns between black and nonblack men revealed that black men were more likely to receive other therapies prior to radium, including chemotherapy. Conclusions: Using a large, heterogeneous, real world cohort, we describe differences in treatment patterns and outcomes with radium-223 between black and nonblack men with mCRPC. While black men had a lower risk of mortality in this cohort, they had higher PSA and ALP levels when receiving radium-223. They were also more likely to receive other therapies prior to radium-223, indicating a possible delay in radium use in black men.

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Prostate cancer care in Canada: Informed decision-making, patterns of care, and treatment trends.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.289 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 289-289

Author(s):

Kim Tran ◽

Rami Rahal ◽

Carolyn Sandoval ◽

Geoff Porter ◽

Sharon Fung ◽

...

Keyword(s):

Decision Making ◽

Treatment Decision ◽

Treatment Patterns ◽

Informed Decision ◽

Decision Making Process ◽

Informed Decision Making ◽

Treatment Decision Making ◽

Trends Over Time ◽

Treatment Trends ◽

Over Time

289 Background: Because treatment options for localized prostate cancer (PCa) have similar survival outcomes but varying side effects, it is important that patients are meaningfully involved in the decision-making process to ensure the chosen treatment aligns with their needs, wants and preferences. Here, we describe PCa patients’ experience with informed decision-making as well as treatment patterns and trends over time. Methods: Focus groups were conducted with 47 men treated for PCa across Canada to understand their cancer journey experience. Thematic analysis was conducted. A subset of this data on informed decision-making is described. Men (≥ 35 years) diagnosed with localized, low-risk PCa from 2011-2013 were identified using data from six provincial cancer registries. Treatment data were identified by linking hospital/cancer centre data with registry data. Descriptive statistics were generated to describe treatment patterns and trends. Results: Focus group participants expressed a desire to be involved in the treatment decision-making process. While many participants felt completely informed about the treatment choices available to them, others felt they had not been properly engaged in the treatment decision-making process. Some participants felt they had opted for surgery or radiation therapy (RT) without full knowledge of the trade-offs between potential benefits and side effects. Others felt they may have made different decisions about their care had they been more informed. From registry data, in 2013 surgery was the most common primary treatment for men with low-risk PCa ranging from 12.0% in New Brunswick to 41.7% in Nova Scotia. RT was the second most common ranging from 6.4% in New Brunswick to 18.3% in Saskatchewan. Varying majorities of men had no record of surgical or radiation treatment, a proxy for active surveillance. Treatment trends over time suggest an increase in the use of non-active treatment approaches from 60.7% in 2011 to 69.9% in 2013. Conclusions: System performance indicators yield useful information about oncology practice patterns and trends. This information is enhanced when combined with patient level information on how men felt about decision-making around their PCa care.

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Retrospective cohort study of real-world treatment patterns and overall survival in patients with chronic lymphocytic leukemia (CLL) diagnosed between 2010 to 2017 in Ontario, Canada.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e20003 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e20003-e20003

Author(s):

Shazia Hassan ◽

Manjusha Hurry ◽

Soo Jin Seung ◽

Ryan Walton ◽

Ashlie Elnoursi ◽

...

Keyword(s):

Overall Survival ◽

Real World ◽

Population Based ◽

Treatment Patterns ◽

Lymphocytic Leukemia ◽

Administrative Databases ◽

Probability Of Survival ◽

Ontario Cancer Registry ◽

Time To Initiation ◽

Line Of Therapy

e20003 Background: With recent advances in treatment of CLL, it is important to understand emerging treatment patterns and associated outcomes. A population-based study was undertaken to describe the management and survival of CLL patients in Ontario, Canada. Methods: Patients diagnosed with CLL between January 1, 2010 and December 31, 2017 were identified in the Ontario Cancer Registry and linked to provincial administrative databases. Treatment patterns by line of therapy were characterized, including analyses of time to initiation and between therapies. Overall survival was calculated. Results: 2,887 CLL patients were identified (median age 68yr; 67% male). The mean time from diagnosis to first line (1L) treatment was 651 days with 35% of patients receiving fludarabine-cyclophosphamide-rituximab (FCR) based treatment. During the study period, 71% of patients did not yet receive second line (2L) therapy and did not have subsequent follow up, while 19% received 2L ibrutinib. Median time to 2L initiation from 1L treatment discontinuation was 636 days. The table summarizes 1L and 2L therapies. Of the 827 patients on 2L therapy, 65% received ibrutinib. After the introduction of publicly funded novel agents in 2015, a shift in treatment patterns away from FCR and chlorambucil based regimens was observed. Overall mean survival for the cohort from diagnosis was 6.8yrs, and mean 5 year probability of survival was 72.4%. Conclusions: A shift in treatment patterns for CLL can be seen with the introduction of newer therapies, such as ibrutinib. The results can support healthcare decision-makers by characterizing the size of this patient population, real world treatment patterns and survival outcomes for patients with CLL. [Table: see text]

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Leveraging real world data and AIML to inform smart patient care in oncology.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e20002 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e20002-e20002

Author(s):

Li Zhou ◽

Rob Steen ◽

Lynn Lu

Keyword(s):

Patient Care ◽

Predictive Model ◽

Real World ◽

Model Performance ◽

Treatment Decision ◽

Treatment Patterns ◽

Real World Data ◽

World Data ◽

Co Morbidity ◽

Low Probability

e20002 Background: Identifying optimal therapy options can help maximize treatment outcomes. Finding ways to help improve treatment decision is of great value to achieve better patient care. With the availability of robust patient real world data and the application of state of the art Artificial Intelligence and Machine Learning (AIML) technology, new opportunities have emerged for a broad spectrum of research needs from oncology R&D to commercialization. To illustrate the above advancements, this study identified patients diagnosed with CLL who may progress to next line of treatment in the near future (e.g. future 3 months). More importantly, we can identify treatment patterns which are more effective in treating different types of CLL patients. Methods: This study includes multiple steps which have already been analyzed for feasibility: 1. Collect CLL patients. IQVIA's real world data contains ~60,000 active CLL treated patients. ~2,000 patients have progressed line of treatment in 3 month. 2. Define patients into positive and negative cohorts based on those who have/have not advanced to line L2+. 3. Determine patient profiles based on treatment regimens, symptoms, lab tests, doctor visits, hospital visits, and co-morbidity, etc. 4. Select patient and treatment features to fit an AIML predictive model. 5. Test different algorithms to achieve best model results and validate model performance. 6. Score and classify CLL patients into high and low probability based on the predictive model. 7. Match patients based on feature importance and compare regimens between positive and negative cohort. Results: Model accuracy is above 90%. Top clinical features are calculated for each patient. Optimum treatment patterns between high and low probability patients are identified, with controlling patient key features. Conclusions: Conclusions from this study is expected to yield deeper insight into more tailored treatments by patient type. CLL patients started with oral therapy(targeting) have better response than other treatments.

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