Examining Treatment Patterns and Real-World Outcomes in Chronic Lymphocytic Leukemia Using Administrative Data in Ontario

Information on the real-world experience of Canadians diagnosed with chronic lymphocytic leukemia (CLL) is limited. This study was conducted to report treatment patterns and outcomes of CLL using Ontario administrative data. A retrospective cohort study was conducted in patients diagnosed with CLL between 1 January 2010 and 31 December 2017 identified in the Ontario Cancer Registry (OCR). Data were accessed using the Institute of Clinical Evaluative Sciences (ICES), which collects various population-level health information. In the Ontario Cancer Registry, 2887 CLL patients receiving treatment and diagnosed between 2010–2017 were identified. Fludarabine, cyclophosphamide and rituximab (FCR) chemoimmunotherapy was most frequently used as a first line, but use declined since ibrutinib and obinutuzumab combinations were funded in 2015. In patients treated with frontline FCR, survival at year one was 89% pre-2015 and 96% post-2015; at year four, survival was 73% and 87%, respectively. Survival in patients treated with frontline chlorambucil was 76% pre-2015 and 75% post-2015 in year 1, and 45% and 56% in year 3. Our analysis shows that, as the treatment landscape for CLL has shifted, use of newer and novel agents as a first line or earlier in the relapsed/refractory setting has resulted in improved survival outcomes.

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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 Treatment Patterns, Adverse Events, Resource Use, and Costs Among Commercially Insured, Younger Patients with Chronic Lymphocytic Leukemia in the USA: A Retrospective Cohort Study

Advances in Therapy ◽

10.1007/s12325-020-01350-w ◽

2020 ◽

Vol 37 (7) ◽

pp. 3129-3148 ◽

Cited By ~ 2

Author(s):

Shaum M. Kabadi ◽

Aimee Near ◽

Keiko Wada ◽

Chakkarin Burudpakdee

Keyword(s):

Cohort Study ◽

Chronic Lymphocytic Leukemia ◽

Adverse Events ◽

Resource Use ◽

Real World ◽

Retrospective Cohort ◽

Treatment Patterns ◽

Lymphocytic Leukemia ◽

Younger Patients ◽

The Usa

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Correction to: Real-World Treatment Patterns, Adverse Events, Resource Use, and Costs Among Commercially Insured, Younger Patients with Chronic Lymphocytic Leukemia in the USA: A Retrospective Cohort Study

Advances in Therapy ◽

10.1007/s12325-020-01400-3 ◽

2020 ◽

Vol 37 (7) ◽

pp. 3149-3149

Author(s):

Shaum M. Kabadi ◽

Aimee Near ◽

Keiko Wada ◽

Chakkarin Burudpakdee

Keyword(s):

Cohort Study ◽

Chronic Lymphocytic Leukemia ◽

Adverse Events ◽

Resource Use ◽

Real World ◽

Retrospective Cohort ◽

Treatment Patterns ◽

Lymphocytic Leukemia ◽

Younger Patients ◽

The Usa

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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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PCN124 REAL-WORLD HEALTHCARE RESOURCE UTILIZATION AND TOTAL COST OF CARE AMONG US MEDICARE PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA RECEIVING FIRST-LINE IBRUTINIB VS CHEMOIMMUNOTHERAPY

Value in Health ◽

10.1016/j.jval.2020.04.1614 ◽

2020 ◽

Vol 23 ◽

pp. S44-S45

Author(s):

Q. Huang ◽

B. Emond ◽

M.H. Lafeuille ◽

D. Gupta ◽

P. Lefebvre ◽

...

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Resource Utilization ◽

Real World ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Cost Of Care ◽

Lymphocytic Leukemia ◽

First Line ◽

Total Cost ◽

Medicare Patients

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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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