Dr Shadman on Dose Reductions With Ibrutinib in Real-World CLL

Mazyar Shadman, MD, MPH, Innovators Network Endowed Chair, associate professor, Clinical Research Division, Fred Hutch Cancer Center; associate professor, Medical Oncology Division, University of Washington School of Medicine, discusses real-world patient outcomes following adverse effects (AEs) and dose reduction of first-line ibrutinib in Medicare beneficiaries with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma. These data were shared at the 2024 ASCO Annual Meeting.

Using Medicare claims data, the study identified patients who started treatment with ibrutinib between January 2014 and September 2020 and experienced an AE following treatment initiation. The analysis compared patients who reduced their dose after the first AE with those who did not. Results showed that patients who underwent dose reduction had a significantly longer median time to next treatment compared with those who did not undergo dose reduction.

This study explored whether early dose reduction in response to AEs could help patients stay on medication longer, Shadman begins. Investigators analyzed Medicare beneficiary claims data, focusing on 2 cohorts of patients who began ibrutinib as first-line therapy for CLL, he explains. One cohort included patients who reduced their dose after the first AE, and the other cohort included patients who did not, Shadman reports. By comparing these groups, investigators found that patients who reduced their dose after the first AE were able to stay on treatment longer, with extended time to the next treatment, which serves as a proxy for progression-free survival, Shadman explains.

In addition to the longer treatment duration, claims data showed that health-related costs, overall costs, CLL-related costs, and CLL-related health resource utilization were all lower for the group with early dose reduction, he states. This indicates that early dose adjustments can be beneficial for patients who experience AEs, helping them remain on the drug and continue to benefit from its efficacy, Shadman shares. This study underscores the importance of considering early dose reduction for patients who cannot tolerate the initial dosage of their therapies, potentially improving their treatment outcomes and reducing health care costs, he concludes.