Real-World Data Show Considerable Variation in DLBCL Regimens for Older Patients

Real-world data showed a high unmet medical need among older patients with diffuse large B-cell lymphoma (DLBCL): Up to 35% of patients were receiving no treatment, and more than 50% were receiving attenuated treatment, according to a study presented at the 2020 ASH Annual Meeting.

“These data show a high unmet medical need among elderly patients with DLBCL who may not be able to tolerate immunochemotherapy regimens that have been evaluated in trials for a carefully selected patient population,” the researchers noted.

Researchers used real-world data from the Flatiron Health (FH) electronic health record (EHR)-derived deidentified database and Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Data from the FH EHRs included 725 patients with a DLBCL diagnosis on or after January 1, 2011, who had follow-up through May 31, 2020. The SEER-Medicare database included 2,613 patients with a DLBCL diagnosis between January 1, 2011, and December 31, 2015, who had follow-up through December 31, 2016. Researchers included patients who were aged ≥80 years at diagnosis.

Among patients in the FH database who received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) as first-line therapy and had available dosing data, those who received <80% of standard full doses for cyclophosphamide 750mg/m² and doxorubicin 50mg/m² at first administration were classified as “reduced-dose” R-CHOP.

In the FH dataset, 117 patients were untreated, as were 915 in the SEER-Medicare dataset. More than half of the treated patients received R-CHOP in the first line of therapy (63% in the FH database and 53% in the SEER-Medicare database); other patients received attenuated regimens, including rituximab plus bendamustine; rituximab plus cyclophosphamide, vincristine, and prednisolone; and rituximab monotherapy.

Patients who received R-CHOP in the first line of therapy had numerically longer median overall survival (FH, 55.0 months [95% confidence interval [CI], 41.8 to not available]; SEER-Medicare, 50.7 months [95% CI, 45.9-62.9]) compared with those who received other regimens. Untreated patients had a median survival of 3.1 months (95% CI, 2.3-5.2) in the FH dataset and 2.0 months (95% CI, 1.8-2.2) in the SEER-Medicare dataset.

Among those who received R-CHOP and had available dosing data, 51% received reduced-dose R-CHOP in the first line of therapy, and overall survival appeared shorter than for patients who received full-dose R-CHOP.

Reference

Shewade A, Olszewski AJ, Pace N, et al. Unmet Medical Need Among Elderly Patients with Previously Untreated DLBCL Characterized Using Real-World Data in the United States. Abstract 1202. Presented at the 62nd American Society of Hematology Annual Meeting & Exposition, December 2-11, 2020.