Overall survival of patients with CLL treated with ibrutinib in the first line compared to second-line ibrutinib after chemotherapy/chemoimmunotherapy
Language English Country England, Great Britain Media print-electronic
Document type Comparative Study, Journal Article
- Keywords
- Chronic lymphocytic leukemia, ibrutinib, overall survival, real-world data, treatment sequencing, trial emulation,
- MeSH
- Adenine * analogs & derivatives therapeutic use MeSH
- Leukemia, Lymphocytic, Chronic, B-Cell * drug therapy mortality MeSH
- Immunotherapy methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Survival Rate MeSH
- Piperidines * therapeutic use administration & dosage MeSH
- Antineoplastic Combined Chemotherapy Protocols therapeutic use administration & dosage MeSH
- Pyrazoles * therapeutic use administration & dosage MeSH
- Pyrimidines * therapeutic use administration & dosage MeSH
- Randomized Controlled Trials as Topic MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
- Names of Substances
- Adenine * MeSH
- ibrutinib MeSH Browser
- Piperidines * MeSH
- Pyrazoles * MeSH
- Pyrimidines * MeSH
OBJECTIVE: To evaluate the overall survival (OS) of patients with chronic lymphocytic leukemia (CLL) receiving either ibrutinib monotherapy as a first-line (1L) treatment or chemotherapy/chemoimmunotherapy-based (CT/CIT) regimens in 1L followed by ibrutinib in the second line (1L CT/CIT-2L ibrutinib) after disease progression by emulating a randomized trial comparing both treatment sequences. METHODS: Patient-level data from the RESONATE-2 trial (NCT01722487) and real-world PHEDRA databases were analyzed. Three scenarios were considered using the following data sources: (1) RESONATE-2, (2) combined RESONATE-2/PHEDRA, (3) combined RESONATE-2/PHEDRA for 1L ibrutinib and PHEDRA for 1L CT/CIT-2L ibrutinib. Propensity score-based weights and inverse probability of censoring weighting were used to adjust for baseline (Scenarios 2 and 3) and time-dependent confounding (all scenarios), and to address potential biases. A weighted Cox proportional hazards model was used to estimate the OS hazard ratio (HR) and 95% confidence interval (CI) for 1L ibrutinib versus 1L CT/CIT-2L ibrutinib. RESULTS: Results from Scenario 1 showed a significantly lower risk of death with 1L ibrutinib compared with 1L chlorambucil followed by 2L ibrutinib (HR 0.35 [95% CI 0.20-0.62]). Results from Scenarios 2 and 3 demonstrated a reduced risk of death with 1L ibrutinib compared with 1L CT/CIT-2L ibrutinib (HR 0.35 [0.21-0.61] and 0.64 [0.39-1.04], respectively). CONCLUSION: The analyses consistently showed a reduced risk of death when ibrutinib was used as a 1L treatment in CLL compared with delaying its use until 2L after CT/CIT regimens, which suggests that initiating ibrutinib in 1L is advantageous for improving survival outcomes.
Department of Hematology Hôpital Lyon Sud Lyon France
Department of Hematology Medical University of Lodz Copernicus Memorial Hospital Lodz Poland
Internal Medicine Hematology and Oncology Department University Hospital Brno Brno Czech Republic
Janssen Cilag GmbH Neuss Germany
Janssen Pharmaceutica NV Beerse Belgium
Janssen Sciences Ireland UC Cork Ireland
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