Hematologic Malignancy Treatment: Community Oncology Updates

The‌ treatment landscape for hematologic malignancies like multiple myeloma (MM) adn chronic lymphocytic leukemia (CLL) is rapidly evolving, bringing new targeted therapies‌ to the community ‍setting. In an interview​ wiht The American Journal of Managed Care^®(AJMC^®)that ‌took place during the 67th American Society of Hematology Annual Meeting and Exposition, Ira Zackon, MD, senior medical director, Ontada, discussed findings from 2 major analyses that explored the real-world adoption, patient characteristics, and treatment paradigms associated with⁣ these novel⁣ agents.^1,2

One study reviewed the rapid uptake of bispecific antibodies for relapsed/refractory MM, noting that real-world patients tend⁢ to be older‌ than those in clinical trials.¹ The other ‌analysis highlighted meaningful real-world‌ discontinuation ​rates for ⁢covalent Bruton tyrosine kinase (BTK) inhibitors in CLL, primarily due to adverse effects (AEs), suggesting advantages for time-limited therapy approaches.² These essential insights into community-based oncology care

A significant discontinuation rate was observed with all covalent ⁢BTK inhibitors, with approximately ‍two-thirds of patients discontinuing treatment during the study period, even with second-generation drugs like acalabrutinib and zanubrutinib. These newer drugs had become preferred first-line options due to their improved safety⁤ profiles ⁣- specifically, lower rates of cardiovascular adverse ⁢events like atrial ⁣fibrillation or⁢ hypertension – and comparable or superior efficacy. However, the study found that nearly 40% of patients discontinued acalabrutinib, around 50% discontinued zanubrutinib, and 56% discontinued ibrutinib. The primary reason for discontinuation was toxicity or adverse⁢ events, though documentation was lacking for about a ​third of discontinuations.

The data suggest a tendency away from continuous therapy, particularly among patients with varying health and performance statuses. This presents a potential limitation to the continuous therapy paradigm, which currently has the most mature follow-up data.Time-limited therapy may offer advantages, and treatment paradigms⁤ are increasingly moving in that direction, both in clinical practice and ongoing trials. Shorter times to discontinuation were linked to lower performance status, more comorbidities, and specific adverse events,⁢ highlighting factors common in real-world settings.

Currently, patients have the option of ‌continuous covalent BTK inhibitor therapy or a time-limited, fixed-duration approach, such as venetoclax (a BCL-2 inhibitor) combined with obinutuzumab (an anti-CD20 ‌monoclonal antibody). The National Comprehensive Cancer Network supports​ combinations like acalabrutinib and venetoclax. Time-limited⁣ approaches‍ offer potential⁤ benefits, including shorter ⁤overall treatment ⁢duration, the possibility of a ‍treatment-free interval to ⁢improve quality of life, and reduced⁢ costs for⁣ both⁤ patients and payers.Combinations are becoming more prevalent, and ongoing clinical trials⁤ will continue to refine treatment strategies.