Final results on effectiveness and safety of Ibrutinib in patients with chronic lymphocytic leukemia from the non-interventional FIRE study

Abstract

We conducted an observational study (FIRE) to understand the effectiveness and safety outcomes of ibrutinib in patients with chronic lymphocytic leukemia (CLL) in France, after a maximum follow-up of five years. Patients were included according to the French marketing authorization in 2016 (i.e. patients with relapsed or refractory CLL or to previously untreated CLL patients with deletion 17p and/or tumor protein p53 mutations unsuitable for chemoimmunotherapy) and could have initiated ibrutinib more than 30 days prior their enrolment in the study (i.e. retrospective patients) or between 30 days before and 14 days after their enrolment (i.e. prospective patients). The results showed that in the effectiveness population (N = 388), the median progression-free survival (PFS) was 53.1 (95% CI: 44.5-60.5) months for retrospective patients and 52.9 (95% CI: 40.3-60.6) months for prospective patients and no difference was shown between the PFS of patients who had at least one dose reduction versus the PFS of patients without dose reduction (p = 0.7971 for retrospective and p = 0.3163 for prospective patients). For both retrospective and prospective patients, the median overall survival was not reached. The most frequent treatment-emergent adverse event of interest was infections (57.6% retrospective; 71.4% prospective). A total of 14.6% of the retrospective patients and 22.4% of the prospective patients had an adverse event leading to death. Our findings on effectiveness were consistent with other studies and the fact that patients with dose reductions had similar PFS than patients without dose reduction is reassuring. No additional safety concerns than those already mentioned in previous studies could be noticed.Trial registration ClinicalTrials.gov, NCT03425591. Registered 1 February 2018 - Retrospectively registered.

Keywords: Chronic lymphocytic leukemia; Effectiveness; Ibrutinib; Real-world evidence; Safety.

Fig. 1

Progression-free survival for CLL patients by type of inclusion (Effectiveness population, N = 388)

Fig. 2

Time from ibrutinib initiation to overall survival for CLL patients by type of inclusion (Effectiveness population, N = 388)

Fig. 3

Time to next therapy, excluding patients restarting ibrutinib as subsequent therapy, for CLL patients by type of inclusion (Effectiveness population, N = 388)

Fig. 4

Progression-free survival for CLL patients according to mutation status (del17p and/or TP53) for retrospective patients (a) and prospective patients (b) (Effectiveness population, N = 388)

Fig. 5

Progression-free survival for CLL patients with at least one ibrutinib dose reduction versus no dose reduction for retrospective patients (a) and prospective patients (b) (Effectiveness population, N = 388)