Real-World Treatment Patterns, Survival, and Economic Burden Among Elderly MCL Patients Previously Treated With cBTKis

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 24; no. 10; pp. e350 - e358.e1
• Main Authors: Squires, Patrick, Puckett, Justin, Ryland, Katherine Elizabeth, Kamal-Bahl, Sachin, Raut, Monika, Doshi, Jalpa, Huntington, Scott F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2024
• Subjects: Agammaglobulinaemia Tyrosine Kinase - antagonists & inhibitors; Aged; Aged, 80 and over; Cost of Illness; Costs; Female; Humans; Ibrutinib; Lymphoma, Mantle-Cell - drug therapy; Lymphoma, Mantle-Cell - economics; Lymphoma, Mantle-Cell - mortality; Lymphoma, Mantle-Cell - therapy; Male; Mantle cell lymphoma; Medicare; Protein Kinase Inhibitors - economics; Protein Kinase Inhibitors - therapeutic use; Retrospective Studies; Unmet need; Costs; Unmet need; Medicare; Ibrutinib; Mantle cell lymphoma
• ISSN: 2152-2650; 2152-2669; 2152-2669
• DOI: 10.1016/j.clml.2024.05.023

While covalent Bruton's tyrosine kinase inhibitors (cBTKis) have become a standard of care treatment for relapsed/refractory mantle cell lymphoma (R/R MCL), response duration is limited and resistance to BTKi and/or adverse events develop in a subset of patients. However, little real-world evidence on post-cBTKi clinical and economic outcomes exists for these patients.
This retrospective study used 2010 to 2019 U.S. Medicare claims, to identify elderly (≥ 66 years) patients with newly-diagnosed MCL who received third-line (3L) treatment and had evidence of cBTKi use in a prior line of therapy. Outcomes were assessed ≥ 12-months post 3L-treatment initiation and included treatment patterns, all-cause and MCL-related HRU and costs, and overall survival.
The final sample contained 230 elderly patients with R/R MCL receiving 3L treatment who had cBTKi use in a prior line of therapy (mean age 75.0, 21.7% age > 80 years; 67.4% male; 93.9% White). Common 3L treatments included chemotherapy (26.1%), lenalidomide (18.7%), and bortezomib (18.3%); 1-quarter (25.7%) of patients received a cBTKi (17.8% ibrutinib; 7.8% acalabrutinib). Overall survival was poor from 3L treatment initiation (median OS = 9.4 months; 1-years survival rate = 43.7%). Patients exhibited high rates of HRU (73.6% experienced hospitalization) and substantial costs ($145,726) in the 12-months after 3L initiation.
A large unmet need exists in this patient subpopulation, highlighting the importance of ongoing development of novel therapeutics.
Treating older adults with relapsed mantle cell lymphoma (MCL) beyond Bruton tyrosine kinase inhibitors may be challenging. We conducted a real-world study of 3L + MCL therapy using 100% Medicare claims and found limited treatment options. Survival was poor and healthcare costs were high. These findings confirm a large unmet need and highlight the importance of ongoing development of novel therapeutics.