PF496 TREATMENT PATTERNS AMONG PATIENTS WITH RELAPSED FOLLICULAR LYMPHOMA
Authors: S.R. Reddy, E. Chang, L. Nastoupil, S. Gokhale, R. Copher, Z. Clancy
Journal: HemaSphere (2019)

Background: Follicular lymphoma (FL) is the second most common form of non‐Hodgkin lymphoma, accounting for about 35% of cases in the United States. Despite a high 5‐year survival rate (53–91%), FL is considered incurable with cycles of relapse and remission occurring frequently. Treatment may involve radiation or chemoimmunotherapy (drug treatment) according to disease stage. However, standard guidelines recommend a number of options for both first‐ (1L) and second‐line (2L) therapy with no dominant choice for clinical decision‐makers. Aims: To examine real‐world 2L treatment patterns among patients with relapsed FL. Methods: Using 2007–2014 Surveillance, Epidemiology, and End Results (SEER)‐Medicare data, we identified patients diagnosed with FL (International Classification of Diseases for Oncology, 3rd edition [ICD‐O‐3] codes 9690–9691, 9695, 9698) who initiated a target 1L treatment for FL during the identification period of January 1, 2008 to December 31, 2012. Date of diagnosis occurred on or before the first claim date for 1L treatment (index date). Patients using any drug treatment for FL before the index date were excluded. Patients were followed for ≥1 year (except due to death) until death, disenrollment, or study end. Target 1L treatments were identified by the presence of a claim for all agents (except prednisone): rituximab monotherapy (R‐mono); rituximab + bendamustine (BR); R‐CVP (rituximab, cyclophosphamide, vincristine, prednisone); R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). As physicians may modify the combination of CHOP agents, patients who were not on R‐CVP but received rituximab and ≥1 agent of cyclophosphamide, doxorubicin, and vincristine were classified as R‐CHOP‐like. Patients who started 2L therapy after ≥4 cycles of index therapy and a remission period of ≥90 days (≥180 days for R‐mono) were considered to have relapsed FL. New drug treatment received before completing all cycles and achieving full remission was considered part of the previous line of therapy. We examined 2L treatment patterns, such as the type and frequency of 2L regimens. Baseline measures included demographics, Ann Arbor staging, and number of chronic conditions. Results: 2,515 patients who initiated 1L therapy for FL and who met all selection criteria were identified. Mean age (standard deviation [SD]) was 74.1 (8.2) years, 87.2% were white, and 53.8% were female. All stages were represented: stage III (28.4%), IV (26.8%), I (20.8%), II (17.1%), and unknown (6.8%). Mean (SD) number of chronic conditions was 6.9 (2.1). Two‐thirds of patients (66.4%) completed 1L therapy and entered remission during follow‐up. Among these patients, 26.4% (n = 440) experienced a relapse and began 2L therapy. R‐mono, R‐CHOP‐like, R‐CVP, and BR were most commonly initiated as 2L therapy (97.2%). Many patients moved on to a second (12.3%) or third or more (5%) 2L regimen until completing a full course of therapy or reaching study end. Considerable heterogeneity was observed in 2L regimens (Table). In addition, treatment failure was somewhat common; among the 206 patients who completed 2L therapy and entered remission 27.7% (n = 57) experienced relapse and began third‐line therapy. Summary/Conclusion: Many patients with FL who receive 1L therapy experience relapse and move on to subsequent lines of therapy. Regimens received as part of 2L therapy are heterogeneous and over a quarter of 2L regimens completed result in failure, suggesting an unmet need for alternative treatment options among relapsed FL patients. image