Key takeaways:
- Considerably fewer Hispanic sufferers obtained most well-liked first-line therapy for CLL vs. white sufferers.
- Use of most well-liked first-line therapy additionally different by apply kind.
CHICAGO — Researchers noticed inequities in receipt of first-line most well-liked therapies amongst a cohort of sufferers with power lymphocytic leukemia, in keeping with outcomes of a retrospective observational examine.
The findings, offered at ASCO Annual Assembly, particularly confirmed disproportionate use of chemoimmunotherapy and ibrutinib (Imbruvica; Janssen, Pharmacyclics) by race/ethnicity, in addition to variations in use of most well-liked focused therapies by apply kind and time interval.
Use of most well-liked first-line therapy for CLL different by race/ethnicity and apply kind. Picture: Adobe Inventory.
Adam Kittai
“This analysis continues to focus on that entry to care, and particularly entry to essentially the most fashionable therapies, could also be contributing to racial disparities noticed in CLL. It additionally highlights the impression modifications in tips have on prescribing patterns, emphasizing their significance,” Adam Kittai, MD, affiliate professor of medication within the division of hematology and medical oncology at Mount Sinai, instructed Healio.
Kittai and colleagues pooled knowledge from the U.S. Flatiron Well being digital well being record-derived deidentified database for 7,528 sufferers with CLL.
They used logistic regression to estimate odds ratios, adjusting for age, intercourse, ECOG efficiency standing, immunoglobulin heavy-chain variable (IHCV), del17p/TP53 mutation standing, time interval and apply kind.
Receipt of most well-liked first-line therapy outlined by Nationwide Complete Most cancers Community tips throughout 4 time durations by race/ethnicity served as the first endpoint.
“We carried out this analysis to find out if all sufferers are handled equitably,” Kittai mentioned. “We now have beforehand proven that Black sufferers have worse OS than white sufferers with CLL taking a look at SEER knowledge and have continued to make use of numerous analysis methodologies to find out why these disparities exist. We now have additionally beforehand proven that there’s a wider disparity in survival for hematologic malignancies which can be amenable to therapy, suggesting that minority teams are much less prone to be handled with novel therapies that may enhance survival.”
Black sufferers (n = 640; median age, 68 years) have been youthful than white sufferers (n = 5,472; median age, 71 years), and extra Hispanic (n = 290) and Black sufferers obtained therapy at group practices vs. white sufferers (86% vs. 80%).
Similarities within the presence of del17p/TP53 mutation have been noticed throughout races/ethnicities. Nevertheless, Black sufferers have been extra prone to have unmutated IGHV in contrast with white sufferers (77% vs. 56%).
Outcomes confirmed considerably fewer Hispanic sufferers obtained most well-liked first-line therapy in contrast with white sufferers (OR = 0.61; 95% CI, 0.47-0.79). Similarities have been present in receipt of most well-liked first-line therapies amongst Black and white sufferers (OR = 1.07; 95% CI, 0.89-1.3).
“Hispanic sufferers appeared much less prone to be handled with a most well-liked routine per the NCCN tips, regardless of gaining access to oncologic care — this distinction in treating with most well-liked regimens could result in worse outcomes,” Kittai mentioned.
Researchers noticed a big affiliation between updates to NCCN tips and receipt of most well-liked first-line therapy by apply kind (P = .0005).
Of be aware, researchers noticed enhancements in adherence to most well-liked therapy throughout practices throughout 2020. Nevertheless, adherence decreased after the prioritization of second-generation therapies.
“We have to provide you with methods to lower gaps to entry to care,” Kittai mentioned. “This probably wants to come back high down by means of authorities initiatives. For physicians, we should always proceed to try to deal with all sufferers equally irrespective of their race. Moreover, new concepts are wanted to deliver care to the place our sufferers stay, which may probably mitigate obstacles to care.”
For extra data:
Adam Kittai, MD, may be reached at adam.kittai@mssm.edu.
Sources/Disclosures
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Kittai A, et al. Summary e13741.Introduced at: ASCO Annual Assembly; Might 30-June 3, 2024; Chicago.
Disclosures:
Kittai experiences honoraria from AbbVie, AstraZeneca, Eli Lilly & Co. and Janssen; consulting or advisory roles with AbbVie, AstraZeneca, BeiGene, Bristol Myers Squibb, Eli Lilly & Co., Galapagos NV and Kite Pharma; analysis funding from AstraZeneca and BeiGene; and serving on audio system bureau for BeiGene. Please see the examine for all different authors’ related monetary disclosures.
