The impact of dose modification and temporary interruption of ibrutinib on outcomes of CLL patients in routine clinical practice

[Jm954]

This paper in Cancer Medicine (18/03/2020) reports on a retrospective study of 209 consecutive CLL patients treated with Ibrutinib outside the context of a clinical trial at the Mayo Clinic.

Results from the study show that among CLL patients treated outside the context of a clinical trial, approximately 40% patients initiated ibrutinib at a reduced dose (<420 mg daily, primarily due to concomitant medications that may increase ibrutinib toxicity and physician prescribing patterns), and approximately 50% patients subsequently undergo a dose modification and/or a dose interruption after initiation of ibrutinib therapy. Although ibrutinib starting dose and dose modifications did not impact EFS and OS, temporary dose interruptions during therapy were associated with shorter EFS and shorter OS.

Dose interruptions were also fairly common in routine clinical practice, with an estimated 60% patients requiring dose interruptions at 2 years. Notably, temporary dose interruptions were associated with shorter EFS and OS, suggesting that patients who are able to adhere to treatment better may derive more benefit.

These results complement data from Barr and colleagues where CLL patients treated on the RESONATE trial who demonstrated sustained adherence to ibrutinib therapy (examined during the first 8 weeks on therapy) had an improved progression‐free survival and OS.5 Findings from our study extend these observations to include adherence to therapy not only during the first 8 weeks, but during the entire course of therapy may impact outcomes.

These findings should be interpreted with caution since patients who are able to adhere to therapy are generally those who are able to tolerate treatment better, and have no major comorbidities. In this regard, patients who held ibrutinib for surgical procedures had better EFS and OS compared to those patients who held ibrutinib for toxicity.

More detail here: onlinelibrary.wiley.com/doi...

Stay safe

Jackie

[Beattiem-UK]

That's very interesting, thanks Jackie.

[Wroxham]

Thanks Jackie.

Sue

[annmcgowan]

Thanks Jackie very encouraging.

Stay safe

Ann

[country76]

Thanks Jackie I did interupt for 7 days or less due to toxicity.