The following article features coverage from the 2021 Annual Meeting of the Society of Hematologic Oncology (SOHO). Click here to read more of Cancer Therapy Advisor’s conference coverage.

Many patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) may not be treated in accordance with National Comprehensive Cancer Network (NCCN) guidelines, a registry study suggests.

The study did indicate that, among patients who underwent biomarker testing, most received guideline-recommended treatment regimens. However, more than two-thirds of patients studied did not undergo biomarker testing, which is not in line with recommendations.

These findings were presented at the Annual Meeting of the Society of Hematologic Oncology (SOHO) by Nilanjan Ghosh, MD, PhD, of Levine Cancer Institute in Charlotte, North Carolina.


Continue Reading

“The treatment paradigm for patients with CLL/SLL has evolved in the last few years with the approval of novel agents and an increased understanding of the impact of prognostic biomarker testing on patient outcomes,” Dr Ghosh said. 

“We know that NCCN guidelines provide clinical recommendations on evolving standards of care and are widely used in the US and internationally, but application of these practices in clinical settings can vary.” 

Dr Ghosh and colleagues set out to determine if patients enrolled on the informCLL registry (ClinicalTrials.gov Identifier: NCT02582879) were managed according to the NCCN Guidelines for CLL/SLL v.2.2017. This version of the guidelines was chosen because 74% of patients were enrolled in the registry in 2017 or later.

The study included 1462 patients enrolled in the registry from October 2015 to June 2019. Most patients (93%) were treated in community settings.

The patients’ median age was 71 years (range, 34-95 years), and 58% were previously untreated at baseline. Patients were followed for at least 2 years. 

Dr Ghosh noted that, contrary to NCCN recommendations, biomarker testing was performed “in a fraction of patients.” Nearly three-quarters of patients (73%) had no data available for del(17p) or TP53 mutation status.  

FISH testing was performed in 28% of patients, TP53 mutation testing was performed in 11%, and IGHV mutational testing was performed in 12%. Of those tested, 24% had del(17p), 27% had TP53 mutations, and 70% had unmutated IGHV.

“Most patients with prognostic testing results available received NCCN-recommended regimens,” Dr Ghosh said. 

In all, 62% of patients with del(17p) or TP53 mutations received NCCN-recommended regimens, but 25% received non-recommended chemoimmunotherapy with bendamustine plus rituximab (BR) or fludarabine plus cyclophosphamide and rituximab (FCR). 

Most patients without del(17p) or TP53 mutations received NCCN-recommended regimens across age or comorbidity groups, but some did not. Among previously untreated patients without del(17p) or TP53 mutations who were frail and had significant comorbidities, 24% received BR, which is not recommended.

Among patients without del(17p) or TP53 mutations who were elderly or were younger with significant comorbidities, 6% of previously untreated individuals received FCR, and 12% of those with relapsed/refractory disease received rituximab, neither of which is recommended. 

Among patients without prognostic testing data, the most common treatments were ibrutinib (44%), chemoimmunotherapy (32%), and anti-CD20 monotherapy (14%).

“One-third of the patients in the registry with no data available on del(17p) or TP53 mutation may have received suboptimal treatment with chemoimmunotherapy,” Dr Ghosh said. “These results underscore the need for awareness of NCCN guideline recommendations to better inform treatment decisions, particularly in the community setting.”  

Disclosures: This research was supported by Pharmacyclics, LLC. Some study authors declared affiliations 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 SOHO 2021 by visiting the conference page.

Reference 

Ghosh N, Brander D, Mato AR, et al. Insights from the informCLL registry: Real-world application of NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ®) for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL). Paper presented at: Annual Meeting of the Society of Hematologic Oncology (SOHO); September 8-11, 2021.