Black Patients Less Likely to Receive Novel Agents as First-Line CLL Therapy

The following article features coverage from the 2021 American Society of Hematology Annual Meeting. Click here to read more of Cancer Therapy Advisor’s conference coverage.

Black patients with chronic lymphocytic leukemia (CLL) are less likely than White patients to receive novel agents (NAs) as first-line treatment, according to a retrospective study of patients in the Veterans Health Administration (VHA).

However, the difference between the groups lessened over the study period. These findings were presented at the 2021 American Society of Hematology (ASH) Annual Meeting.

For this study, investigators evaluated the uptake of NAs — ibrutinib, idelalisib, and venetoclax — in the VHA, where access to care was equal for Black and White patients. Eligible participants were adult patients with CLL who were managed in the VHA from 2014 to 2017.

The investigators reviewed data regarding start and stop dates for first-line CLL therapies and data for up to 20 years before CLL treatment initiation to define the baseline variables.

A 2-step nominal logistic regression model was used to evaluate the effect of race on use of NAs. Bivariable statistical tests were used to compare baseline patient characteristics, and variables with a P value less than .10 were used in the multivariable nominal logistic regression model. P values less than .05 were considered statistically significant.

A total of 565 patients were included — 86% White (485 patients; 99% men) and 14% Black (80 patients; 96% men). Black patients were younger than White patients (mean [SD] age, 66 [60-71] years vs 69 [65-76] years, respectively; P <.0001).

Black patients were less likely to receive NAs compared with White patients (14% vs 26%, respectively; P =.0165), although this difference decreased during the study period.

Black patients received traditional chemotherapy/chemoimmunotherapy more frequently than White patients (86% vs 74%, respectively). White and Black patients had similar treatment outcomes and health care use, including emergency room visits, urgent care visits, hospital admissions, and death.

In a multivariate analysis, Black race (P =.0243; odds ratio, 0.47; 95% CI, 0.24-0.94) and fiscal year (P =.0019) were the only variables that independently predicted NA use.

“There was a statistically significant difference in the use of NAs between Black and White patients with CLL in the VHA for the study period,” the investigators wrote in their abstract. “However, when NA use was examined by year, the disparity was largest in the early study years, with reduced differences in NA utilization over time.”

Several study limitations were noted, including the smaller population, the fact that some biologic factors were not assessed, and potential confounding factors, such as physician experience with NA use.

“With the introduction of more NAs, the VHA should pay close attention to ensure all patients receive equal access to new therapies,” the investigators wrote. “We hope to implement interventions to ensure that patients of all races have equal access to NAs as soon as they are introduced.”

Disclosures: This research was supported by AstraZeneca. Some study authors declared an affiliation with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Read more of Cancer Therapy Advisor’s coverage of the ASH 2021 meeting by visiting the conference page.

Reference

Lucero KT, Obodozie-Ofoegbu OO, Nooruddin Z, et al. Uptake of novel agents (NAs) as first-line treatments for Black and White patients with chronic lymphocytic leukemia (CLL) in the Veterans Health Administration (VHA): A retrospective cohort study. Presented at ASH 2021; December 11-14, 2021. Abstract 340.