SAN ANTONIO, TX — In 2015, the American Society of Clinical Oncologists (ASCO) named the transformation of chronic lymphocytic leukemia (CLL) the Cancer Advance of the Year. Starting with the first four new treatments that delivered greater efficacy with fewer adverse effects, novel treatments have dramatically changed the course of the disease for many older patients, giving many of them the first opportunity for effective treatment in light of the toxicity of previous regimens.

The new developments would appear tailor-made for the VA, which has an overwhelming older population with multiple comorbidities. On the other hand, as a large healthcare system, change can sometimes come more slowly than desired.

A team of researchers from the South Texas Veterans Health Care System, the University of Texas at Austin College of Pharmacy, and other organizations sought to understand how quickly the VA adopted the new treatments for patients with CLL. Results of their study were published in conjunction with the 2020 ASCO Annual Meeting held May 29-31.1

The researchers identified 26,879 veterans with CLL treatment by the VA between October 1, 2013 and May 31, 2018 and followed for at least six months. Patients resided in all 18 VISNs, representing all 50 states and U.S. territories.

During the period, 3,670 patients received at least one of the 12 CLL therapies on which the team focused.  Patients had a median age of 69 years, with 26% more than 75 years old. The median age adjusted Charlson comorbidity score was 6, and 6% had experienced Agent Orange exposure.

Of the novel agents, ibrutinib was the most commonly received, accounting of 89% of novel agent usage. During the 19 months of the study, the use of ibrutinib increased 700%. Venetoclax and idelalisib were the most commonly used novel agents in the line of therapy following ibrutinib, with venetoclax used in 42% of cases and idelalisib used in 30%.

Traditional chemotherapy or chemoimmunotherapy declined throughout the period across all lines of therapy, but as of 2018, 17% of patients still received these traditional treatments. Patients who received chemotherapy or chemoimmunotherapy had 200% to 600% higher rates of incident diffuse large B cell lymphoma than those who received ibrutinib. Ibrutinib was the most common subsequent line following chemotherapy or chemoimmunotherapy.

  1. Nooruddin Z, Le H, McHugh D, Ryan K, Jones X, Obodozie-Ofoegbu OO, Teng C, Eaves AC, Frei CR. “The shift in therapies for the treatment of chronic lymphocytic leukemia (CLL) patients in the US Veterans Health Administration (VHA) from 2013-2018.” Abstract e19339. 2020 ASCO Annual Meeting. May 29-31, 2020.