Multiple Myeloma and Chronic Lymphocytic Leukemia: Immediate Impact of 2015 ASCO & EHA Presentations on Clinical Practice

Introduction

OBR and MDoutlook are pleased to share excerpts from the most recent MDoutlook’s OncoPolls™ from this year’s ASCO and EHA annual meetings. This report highlights certain presentations concerning the treatment of Chronic Lymphocytic Leukemia (CLL) and Multiple Myeloma (MM). This research is based on separate surveys conducted for each hematologic malignancy. The full complimentary report is available through MDoutlook per details below.

OncoPoll™ Methodology

  • Primary research phase involved global surveys to verified and validated hematologic and medical oncologists with an identified clinical interest in hematologic malignancies utilizing targeting parameters within the proprietary MDoutlook® global cancer treater panel
  • Timing: July 2015. Launched shortly after close of 2015 American Society of Clinical Oncology (ASCO) Annual Meeting, held in Chicago, IL., May 29-June 2, 2015 and the 20th Congress of European Hematology Association (EHA), held in Vienna, Austria, June 11-June 14, 2015
  • Fielding via interactive web-based survey instruments, utilizing proven MDoutlook methodology and proprietary technology
  • Links to discussed abstracts on the ASCO and EHA websites were provided within the survey
  • Responses: 79 global physicians in CLL survey and 75 global physicians in multiple myeloma survey

Impact of ASCO/EHA Presentations on Ibrutinib Usage in CLL

Key Conclusions

  • Ibrutinib usage in fludarabine refractory and relapsed CLL will increase from ~1/4 of patients to over 1/3 of patients
    • Usage in fludarabine refractory patients expected to see a 77% increase
    • 58% increase in usage is expected for relapsed CLL
  • In the 1st line setting, ibrutinib usage will also increase, dependent on the patient subtype
  • Overall, the clinical importance of the presentations of the HELIOS clinical trial was rated as 4.25 on a 1-5 scale (data not shown)

Impact of ASCO/EHA Presentations on Usage of anti-CD20 Antibodies in CLL

Key Conclusions

  • Based on the presentations at ASCO & EHA (Complement 2 trial), physicians expect to double their usage of obinutuzumab and ofatumumab in CLL
    • Rituximab will remain the dominant choice, with only an absolute loss of ~5% of CLL patients receiving it
  • Overall, the clinical importance of the Complement 2 presentations was rated as 3.54 on a 1-5 scale (data not shown)

Awareness and Expected Impact of Selected New Agents for CLL

Key Conclusions

  • 87-88% of physicians have at least some awareness about the bcl-2 inhibitor venetoclax and the PI3K inhibitors duvelisib and TGR-1202
  • Physicians have a very positive outlook for venetoclax, with over 40% expecting this agent to have a large impact on many CLL patients
  • Both new PI3K inhibitors are also positively viewed, albeit slightly less positive than the bcl-2 inhibitor
    • Little to no differences are currently seen between duvelisib and TGR-1202

Expected Usage of Elotuzumab Today in Relapsed / Refractory Myeloma, if Commercially Available

Key Conclusions

  • Overall, respondents would use elotuzumab in 58% of their MM patients with refractory disease and 52% of their relapsed MM patients
  • Based on current presentations, ALL respondents would use it in at least some of their MM patients
  • ~40% of physicians would treat most (>60%) of their relapsed / refractory MM patients with elotuzumab

Expected Impact of Daratumumab for the Treatment of Relapsed Multiple Myeloma

Key Conclusions

  • Overall impact rated as 5.4 (1 to 7-point scale)
  • 81% of the respondents rate daratumumab as 5 or higher
    • Nobody rates its impact as “Little or none” (1)

Treatment of Relapsed MM: Kd Expected to Surpass Vd

Key Conclusions

  • Kd (carfilzomib + dexamethasone) expected to show >50% relative increase in usage in relapsed multiple myeloma, to 38% of patients
  • Expected usage of Vd (bortezomib + dexamethasone) will decrease by ~20% to 1/3 of patients

Conclusions: Immediate Impact of 2015 ASCO & EHA Presentations on Clinical Practice for CLL & MM

CLL

  • Both the HELIOS and Complement 2 clinical trials will impact the CLL treatment landscape
    • Ibrutinib usage is expected to rise by 50% to 110% across all CLL subgroups in the next 6 months
    • Anti-CD20 mAb usage in CLL is slowly shifting from 1st generation rituximab to 2nd / 3rd generation ofatuzumab and obinutuzumab
  • Physicians have very high expectations for the BCL-2 Inhibitor venetoclax in CLL
    • The new PI3K inhibitors duvelisib and TGR-1202 are also positively viewed

Multiple Myeloma

  • The immune-oncology revolution has come to multiple myeloma with 2 new monoclonal antibodies: the anti-CS1 mAb elotuzumab and the anti-CD38 mAb daratumumab
  • Virtually all oncologists would use elotuzumab in at least some of their relapsed / refractory myeloma patients if it were commercially available today
    • 40% of respondents reported they would use it in 60% or more of their patients
    • Overall, ~50-60% of relapsed / refractory myeloma patients would receive it as treatment
  • Carfilzomib (Kd) is expected to become the preferred proteasome inhibitor over bortezomib (Vd) in the therapy of relapsed MM

For a more detailed analysis report, please click here to download the full report.

Submitted by Robert Stephan, Sr. Director Medical Services and Strategy, and Jan Heybroek, President MDoutlook.

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