Racial Differences in Ibrutinib Treatment Outcomes in Patients With CLL: A Real-World Analysis

In a groundbreaking study, Jacqueline Barrientos MD, MS, from the Zucker School of Medicine at Hofstra/Northwell Multispecialty Center, New York, and Mount Sinai Comprehensive Cancer Center, Miami, Florida, and colleagues aimed to fill in the gaps left by a lack of research data on the tolerability of the Bruton tyrosine kinase inhibitor (BTKi) ibrutinib in Black patients with chronic lymphocytic leukemia (CLL) who received the drug. To understand the racial disparities in medical treatment schemes, the study authors compared the outcomes with the majority of previous clinical trials, which largely included White patients.

Dr Barrientos and colleagues followed two community networks and one academic practice for 6 months to find their results. In total, 180 patients with CLL who were treated with ibrutinib were followed in this study. Patients that passed away before the end of the study were also included. All the data used was found in electronic medical records. Patients in this study initiated treatment between March 2014 and February 2020.

The authors analyzed 482 CLL patients being treated with Ibrutinib, including a subgroup of 37 (7.7%) Black patients. It found that rates of dose modifications, including discontinuations, reductions, and holds were higher in real-world settings than in clinical trials due to adverse events. Among these patients, Black patients experienced similar outcomes as the overall cohort despite lesser representation and had a higher rate of hypertension at baseline.

Analysis showed that patients received ibrutinib for about 19.5 months. The follow-up time was around 28.2 months. At follow-up, 31.1% of patients discontinued treatment with ibrutinib, 16.2% because of adverse effects and 6.4% because of disease progression. No patients in this trial discontinued because of financial reasons. The most common adverse effects found in this study were atrial fibrillation, fatigue, and rash. Most patients discontinued therapy after 29.3 months.

In conclusion, Dr Barrientos and her colleagues observed a similar treatment outcome for Black and White patients. This suggests that the wider accessibility to BTKis like ibrutinib may serve as a potential equalizer in addressing racial disparities in CLL outcomes. However, this depiction needs to be taken in context of the comparatively smaller sample size for Black patients. The study underscores the tremendous value of real-world data in the ability to shed light on treatment challenges not usually seen in clinical trials, which provides more practical and comprehensive information for therapeutic decision-making.

Source:

Barrientos, J.C., Ayed, A.O., Cha, A. et al. Results from a Real-World Multicenter Analysis of 482 Patients with Chronic Lymphocytic Leukemia Treated with Ibrutinib: A Look at Racial Differences. Targ Oncol 18, 727–734 (2023). https://doi.org/10.1007/s11523-023-00988-0