How Comorbidities May Affect Response to Idelalisib-Based Therapy in CLL
Posted: Wednesday, September 23, 2020
Although comorbidities can influence the outcome of patients with chronic lymphocytic leukemia (CLL) treated with chemotherapy, they do not seem to be associated with inferior outcomes in patients treated with idelalisib plus anti-CD20 therapy. Alexey V. Danilov, MD, PhD, of the City of Hope National Medical Center, Duarte, California, and colleagues conducted a retrospective analysis of two clinical trials and published their findings in the British Journal of Haematology.
The study population consisted of 481 patients with CLL who were enrolled in two separate phase III, randomized trials studying the effects of adding idelalisib to either ofatumumab or rituximab (both anti-CD20 antibodies). A total of 284 patients received combination treatment with idelalisib plus an anti-CD20 antibody, whereas 197 patients received single-agent anti-CD20 therapy. Patients had their comorbidities evaluated using the Cumulative Illness Rating Scale (CIRS) at the time of study enrollment. A total CIRS score greater than 6 represented a high disease burden.
Significant comorbidities were seen in 54.9% of patients, and 22.5% of patients had one or more severely affected organ systems. However, the presence of these comorbidities did not seem to have a significant impact on the objective response rate in patients receiving combination therapy. Patients with a CIRS score over 6 had an objective response rate of 79.3% as compared with 88.2% in those with a CIRS score of less than 6 (P = .07). In addition, the cohort with a CIRS score over 6 had a similar median progression-free survival, 16.3 months versus 19.1 months (P = .16). Median overall survival followed this trend, 39.8 months versus 49.8 months.
Of note, patients both with and without comorbidities had improved outcomes when treated with idelalisib as compared with anti-CD20 antibodies alone. In the group with a CIRS score over 6, the median progression-free survival was 16.3 months with combination therapy and 6.9 months with anti-CD20 antibodies alone.
Disclosure: For a full list of authors’ disclosures, visit onlinelibrary.wiley.com.