Australian oncologists are making the most of PBS-listed targeted therapies for chronic lymphocytic leukaemia.
There has been a strong shift away from chemoimmunotherapy and towards targeted agents in the treatment for chronic lymphocytic leukaemia, according to an Australian registry study.
Chronic lymphocytic leukaemia is the leading type of leukaemia seen in adult patients, yet there is little real-world treatment and outcome data available in Australia and New Zealand.
To better understand the demographics, disease characteristics, treatment and outcomes in CLL, researchers examined a cohort of 365 adult CLL patients diagnosed between January 2016 and May 2023 who were enrolled in the Australia and New Zealand Lymphoma and Related Diseases Registry (LaRDR), and published their findings in the Journal of Internal Medicine.
Included patients were predominantly male (65%), while the median age at diagnosis was 68 years. Fluorescence in situ hybridisation testing revealed 54% of patients had a 13q deletion. Patients were followed for a median of 15 months; 139 (38%) commenced first line therapy during the follow-up period.
Most patients (77%) received chemoimmunotherapy as their first-line treatment, with chlorambucil-based treatments (37%) the most common, followed by fludarabine-based (24%) and bendamustine-based (6%) approaches.
The remaining 32% of patients received targeted agents such as acalabrutinib, ibrutinib or zanubrutinib (Bruton’s tyrosine kinase inhibitors) or venetoclax, the B-cell lymphoma 2 inhibitor.
However, the proportion of patients receiving CIT or a targeted agent changed significantly over time. The use of Bruton’s tyrosine kinase inhibitors increased from just 6% to over 70% after PBS funding was implemented. There was also a corresponding decrease in the proportion of patients receiving CIT.
“Management of CLL in Australia and New Zealand is driven by availability of funded treatments,” the researchers noted.
“First-line treatment [use] in this study reflects PBS (Australia) and PHARMAC (New Zealand) drug approvals during the period, with a shift away from CIT to targeted agents, in keeping with emerging evidence in favour of higher efficacy of targeted agents as well as physicians’ preferences for chemotherapy-free treatment approaches over CIT just within a few years after national availability of the targeted drugs.”
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Patients receiving CIT and targeted agents had similar response rates, with respect to progression-free survival, complete response rates or overall response rates.
“This study demonstrates the importance of registry data in tracking emerging treatment patterns in the real world,” the researchers concluded.
In 2021, the Australian Institute of Health and Welfare reported the age-standardised rate of CLL had increased by 20% over the preceding decade to sit at 7.2 cases per 100,000 people.
