ASCO Preview: Treatment Success and Costs

I have to say, I'm a little disappointed in the Follicular Lymphoma presentations at this year's American Society of Clinical Oncology (ASCO) meeting. As I wrote in my last post, I was hoping that the very low number of abstracts (only 20) when they were first released was going to rise as more were added online. But it hasn't. There's just not a lot of research on FL at this year's conference.

I tried to look on Twitter/X to see if there was anything that Lymphoma specialists were excited about. Not so far, at least not for FL. Right now, with the meeting starting tomorrow, there are a lot of oncologists posting selfies in airports, saying how excited they are about heading to Chicago. Good for them -- I always like to see oncologists that are excited about learning new things. It's a medical specialty with high burnout rates, and a get-together like this is good for them. If you have an appointment in the next month, maybe you'll notice a little more happy bounce from your doctor.  (My own oncologist, Dr. H, is part of groups making two presentations. I hope it's good for him.)

But all of that means that, at least for now, there are limited things to write about. I'm hoping in the next few days, as the research is actually presented, there will be some excitement online, and then in the next few weeks, we'll see more of that excitement as oncology websites post videos of Lymphoma specialists being excited. 

So what I'd like to share for now (in the absence of al of that excitement) is "Real-world evaluation of treatment pattern, time to next treatment (TTNT), healthcare resource utilization (HCRU), and cost of care in follicular lymphoma (FL)." As I said in my last post, there is a kind of theme in the small number of abstracts this year on "real world" data -- what happens after clinical trials are over and a treatment has been approved. 

This research looks at data related to measuring treatments in a few different ways. The researchers look at data on almost 6000 FL patients who had treatment for FL between 2019 and 2023. The researchers broke them into groups based on which line of treatment they had received -- first line, or 1L, were receiving treatment for the first time, and then 2L, 3L, and 4L had refractory or relapsed disease (their treatment stopped working or didn't work at all and so they received another line of treatment). The researchers were interested in Time To Next Treatment (TTNT) -- basically, how long a treatment works.

They were also interested in cost. A treatment that costs a lot might be justified if it works for a long time -- long enough that another treatment (and its cost) isn't necessary. In the same way, a less expensive treatment might not be justified if it doesn't last long, and a costlier treatment is necessary sooner.

It's important to point out that this research was sponsored by a pharmaceutical company. Its particular treatment, a BTK Inhibitor, is not included directly in the data, but it certainly has a stake in presenting data that favors its business. (I'm not saying they are falsifying data or anything like that. It certainly seems legitimate. But they could have chosen to not present it at all if it didn't ultimately help them.)

So, as for the results.

For first-line treatment, the most commonly used was Rituxan on its own (32% of patients in the study), followed by Bendamustine-R (27%) and then R-CHOP (22%). I find this kind of interesting in and of itself.  The Rituxan number seems higher than I have seen before. And the two traditional chemotherapies making up about half of all treatments shows that it is still very much in use, despite all of the other options that have been approved. (Important to remember that many approvals are for 3L and 4L, of course). That same order was true for second-line treatment, too. For third line, things change -- R-Squared (Rituxan + Revlimid) was most popular, Obinutuzumab is mor frequently used in place of Rituxan, and "Others" become increasingly more common than Rituxan, R-squared, or chemo combinations. All of this makes sense -- approved, well-known treatments are used first, and then less common (sometimes still in trials) treatments are used as the others stop working. 

Time To Next Treatment (TTNT) decreased with each line, no matter what the treatment. This makes sense, too. I remember being told, 16 years ago, that it was common for FL to take this path. I was told I'd likely need multiple treatments, and with each one, my FL would get more aggressive and the TTNT would get shorter. I don't think that's necessarily how it works for everyone these days -- treatments are getting better and more effective, and it seems like more patients are hitting on a treatment in 2L or 3L that gives them a longer remission. But this data confirms that, for those who do need multiple lines of treatment (that is, those who have a more aggressive type of FL), TTNT is smaller with each line.

Their data on cost is also interesting. The mean total cost of treatment (the treatment itself, the cost of a doctor's visit, etc.) ranged from $40,538 to $74,466, with the cost going up with each line. The mean total cost of care was consistently lowest with Rituxan on its own ($31,704 to $36,197), and highest with CAR-T ($501,493 to $522,378). Again, none of this is a surprise. More common treatments tend to cost less money, and less common ones tend to cost more.

The conclusion that the researchers came to was that things were tougher for FL patients as they had more lines of therapy -- treatments don't last as long, meaning greater financial costs, but also greater physical and emotional costs. They say "These findings suggest the need for better treatment options for patients with FL, especially in 3L and 4L." 

I don't think anyone is going to argue with that conclusion.  We've known for a very long time that patients have greater needs as treatments stop working. But it also helps justify approving and using a new BTK Inhibitor, should one become available. (And that's not a criticism of the sponsor of the research -- it just shows that there is a need that they are hoping to fill. It's data that confirms what we already know.)

So I'll keep reading and watching and listening, and hope that something very exciting pops up soon, as oncologists start to attend sessions at ASCO. It's all still very exciting to me, regardless.