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David A. Bond
CHICAGO – Patients with chronic lymphocytic leukemia treated with ibrutinib or acalabrutinib appeared to be at increased risk for secondary cancers, including lung cancer, prostate cancer and melanoma, according to data presented at the annual meeting from ASCO.
In addition, the results of the study showed that patients with a history of smoking had higher rates of secondary cancers.
"This highlights the importance of smoking cessation in patients with CLL and patients treated with ibrutinib or acalabrutinib and reinforces the importance of routine cancer screening." as part of the preventive care provided to patients with CLL ", David A. Bond, MD, Oncologist of the Division of Hematology and Medical Oncology of the Comprehensive Cancer Center of Ohio State University, said HemOnc today.
It is well known that patients with CLL have an increased risk of contracting a second cancer and that Bruton tyrosine kinase (BTK) inhibitors are very effective against CLL. However, the effect of BTK inhibitors on the risk and characteristics of secondary cancers has not been established.
Bond and colleagues sought to determine the rate and potential risk factors for second cancer in 691 patients (median age: 64 years, extreme, age 24-91, 70% men, 94% white). of LLCs that have received treatment with ibrutinib (Imbruvica; Imbruvica; Pharmacyclics, Janssen) or acalabrutinib (Calquence, AstraZeneca) – therapies targeting BTK protein and extremely effective and widely used for the treatment of CLL – compared to the general population. Patients received a median two previous treatment lines; more than half (56%) have never smoked.
After a median follow-up of 44 months, 20% of patients were diagnosed with non-melanoma skin cancer, 9% with other secondary invasive cancers and 8% with Richter transformation. The cumulative incidence of non-melanoma skin cancers was 7.5% (95% CI, 5.7-9.7) at 1 year, 15.6% (95% CI, 12.8%). 18.5) at 3 years and 23% (95% CI, 19.2-27.1) at 5 years.
The results of a multivariate badysis showed that smoking (HR = 2.77, 95% CI, 1.61-4.78) and low CD8 count at baseline (HR = 0.87 for one double increase, 95% CI, 0.81-0.93) are both badociated with a higher risk of second cancer. .
"This was surprising because the number of CD8s had not yet been demonstrated in patients with CLL," Bond said. "This finding confirms the importance of immune function as one of the major factors badociated with increased cancer rates in patients with CLL."
The researchers estimated the three-year OS at 79% (95% CI, 76-82). Factors badociated with death included CLL / Richter transformation (38%), second cancer excluding Richter transformation (13%), infection (13%), cardiovascular disease (4%), and others causes (13%).
"This study shows that patients receiving ibrutinib or acalabrutinib for CLL continue to have an increased risk of secondary cancers, but do not respond to the possible effects of ibrutinib or # 39; acalabrutinib on this risk, "said Bond. "It might be easier to answer this question by comparing the second-cancer rates of patients enrolled in large prospective clinical trials of ibrutinib or acalabrutinib compared to patients treated with drugs." 39, other treatments. "
Bond said further research should help determine whether other screening interventions could be recommended to improve the early detection of some secondary cancers in all CLL patients. – by Jennifer Southall
Reference:
Bond D et al. Abstract 7511. Presented at: ASCO Annual Meeting; May 31 to June 4, 2019; Chicago.
Disclosures: Bond does not report any relevant financial information. Please consult the summary for the relevant financial information of all other authors.
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