Photo Credit: Nemes Laszlo
Ibrutinib, a Bruton’s tyrosine kinase (BTK) inhibitor, is widely used for chronic lymphocytic leukemia (CLL) due to its effectiveness and lower toxicity compared to chemoimmunotherapy. However, its use is frequently challenged by patient intolerance and treatment discontinuation. A recent large-scale, real-world analysis from Brazil sheds light on these issues, providing insights into ibrutinib’s effectiveness and the factors influencing its discontinuation. This research is from the 66TH ASH Annual Meeting.
The study utilized data from the Brazilian Registry of CLL, which included 278 patients from 29 centers who received ibrutinib monotherapy between 2015 and 2024. Most patients were male, with a median age of 68 years, and many had significant comorbidities. Ibrutinib was used across all lines of treatment, with a median treatment duration of 28 months. Despite its efficacy, discontinuation was reported in 51% of cases, primarily due to toxicity, death, or disease progression. Toxicities were frequent, affecting 51% of patients, and included infections, bleeding, hematologic issues, and cardiac complications. Notably, patients in earlier lines of therapy experienced fewer adverse events compared to those in later lines.
Efficacy outcomes were promising but varied based on treatment timing and genetic factors. Median progression-free survival (PFS) was not reached, with a 4-year PFS rate of 64%. Patients treated in earlier lines showed superior PFS and overall survival (OS) rates compared to those in later lines. Additionally, patients with del(17p)/TP53 mutations experienced shorter PFS but benefitted from treatment. The median time-to-next-treatment increased with the duration of ibrutinib use, highlighting its long-term benefits for sustained therapy.
While the findings affirm ibrutinib’s role in improving outcomes for patients from Brazil with CLL, they underscore the challenges of managing toxicities and late-line therapy.
