Hospital of the University of Pennsylvania, Philadelphia, PA
Meghan Thompson , Chadi Nabhan , Bruce D. Cheson , John Nathan Allan , Paul M. Barr , Alan P. Skarbnik , Ryan Jacobs , Chaitra Shankar Ujjani , Richard R. Furman , Stephen J. Schuster , Nirav Niranjan Shah , John M. Pagel , Danielle M. Brander , Mazyar Shadman , Clive Zent , Nicole Lamanna , Hande H. Tuncer , Frederick Lansigan , Anthony R. Mato , Brian Thomas Hill
Background: Differences in outcomes have been reported in CLL pts receiving chemo±immunotherapy with non-Caucasians and males having inferior outcomes. Less is known if such disparities exist for pts receiving targeted therapies. We investigated how demographics impact outcomes of CLL pts treated with targeted agents. Methods: We analyzed 3 multicenter, retrospective cohort studies of CLL pts treated with ibrutinib (ibr) (front-line (F/L) or relapsed/refractory (R/R) disease) or venetoclax (ven) (R/R disease). Baseline demographics, responses (ORR), discontinuations (DC), progression-free survival (PFS), and overall survival (OS) were stratified by age ( < 65 vs ≥65 yr), sex (male (M) vs female (F)) and race (Caucasian vs other). Cox regression was used for comparisons. Results: 1068 pts were included: F/L ibr (n = 391), R/R ibr (n = 536), R/R ven (n = 141). F/L ibr pts were 38% F, 59% age ≥65 and 8% non-Caucasian. R/R ibr pts were 37% age ≥65 (sex / race data unavailable). R/R ven pts were 34% F, 63% age ≥65 and 13% non-Caucasian. Del17p was similar within all cohorts. AEs were the most common discontinuation (DC) reason in all ibr groups, while CLL progression was most common in ven pts. A higher proportion of M discontinued ven vs F (34% vs 17%). Table 1 includes ORR, PFS, OS and DC stratified by age, sex and race. Conclusions: In the largest series of pts treated with novel agents, we did not find differences in outcomes when stratified by age, sex and race. These data suggest ibr and ven may in part overcome traditional disparities.
AGE: < 65 vs ≥ 65 years | Sex: M vs F | Race: Caucasian vs other | |||||||
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Ibr (F/L) | Ibr (R/R) | Ven (R/R) | Ibr (F/L) | Ibr (R/R) | Ven (R/R) | Ibr (F/L) | Ibr (R/R) | Ven (R/R) | |
ORR | 85% vs 79% | 67% vs 69% | 68% vs 74% | 80% vs 84% | NA | 68% vs 81% | 83% vs 79% | NA | 71% vs 81% |
PFS (HR for ≥ 65 years, F and other race as events) | HR 1.1 (0.6-2.0), p = 0.7 | HR 0.9 (0.6-1.2), p = 0.3 | HR 0.6 (0.3-1.3), p = 0.2 | HR 0.9 (0.5-1.6), p = 0.7 | NA | HR 0.7 (0.3-1.7), p = 0.4 | HR 1.9 (0.7-4.8), p = 0.2 | NA | HR 0.3 (0.03-1.9), p = 0.2 |
OS | HR 2.2 (0.9-5.5), p = 0.1 | HR 1.4 (0.9-2.1), p = 0.1 | HR 0.9 (0.3-2.5), p = 0.8 | HR 0.5 (0.2-1.3), p = 0.1 | NA | HR 0.8 (0.3-2.6), p = 0.7 | HR 1.4 (0.3-5.9), p = 0.7 | NA | No deaths in Non-Caucasians |
DC | 22% vs 25% | 44% vs 47% | 28% vs 28% | 24% vs 24% | NA | 34% vs 17% | NA | NA | NA |
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