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ASH 2020 | Real-world analysis of the impact of del(17p) on ibrutinib efficacy in CLL

Anthony Mato, MD, Memorial Sloan Kettering Cancer Center, New York, NY shares the details of a real-world investigation of outcomes in chronic lymphocytic leukemia (CLL) and small lymphocytic leukemia patients following first-line ibrutinib treatment, stratified by del(17p) status. Comparing over 1000 patients, overall survival was significantly shorter in the del(17p) present group than the del(17p) absent group. Time-to-next-treatment and time to treatment discontinuation were also shorter in the del(17p) present arm. The results impart a greater understanding of the impact of del(17p) in this population, highlighting it as a negative predictive factor. This interview took place during the 62nd American Society of Hematology (ASH) Annual Meeting and Exposition, 2020.

Transcript (edited for clarity)

The ASH meeting, I’ll be presenting a real-world study, looking specifically at patients treated with ibrutinib and in the frontline setting. And the main stratification here was the presence or absence of a deletion 17p. This is an area of tremendous controversy and debate right now as to what’s the best approach for patients in the frontline who have this poor risk prognostic feature...

The ASH meeting, I’ll be presenting a real-world study, looking specifically at patients treated with ibrutinib and in the frontline setting. And the main stratification here was the presence or absence of a deletion 17p. This is an area of tremendous controversy and debate right now as to what’s the best approach for patients in the frontline who have this poor risk prognostic feature.

Some people say continuous BTK inhibitor strategy is mandated. Others say BCL-2 mediated, fixed-dose combinations are also reasonable. And there’s no clear answer. And the study won’t give us an answer. But what it does do is allow us to look at more than 1,000 patients treated with ibrutinib and in the frontline, and then stratify outcomes by deletion 17p.

And the take-home from this particular poster presentation was that overall survival was inferior in this population. And so the message to everyone in the community is that while these agents are wonderful at partially overcoming poor prognostic features of the disease, for patients with poor-risk disease, there’s still work to be done. And outcomes from the perspective of PFS and overall survival do appear to be inferior.

And so, this really welcomes the idea that these patients should still all be considered for clinical trials. And that we do need either other agents or combinations that include a BTK inhibitor and other agents to try to overcome that.

The other message which isn’t mentioned in the presentation is that many of the frontline clinical trials all include a small subset of patients with a deletion 17p. And at the end of the day, we’re never really able to make significant conclusions about those patients because they’re a minority, 5 to 10% of patients.

This really does speak strongly to having individual trials for patients with poor-risk disease, to really better understand outcomes for those patients. And try to come to conclusions that allow us to move the field forward for patients with the poorest risk features of the disease.

 

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