Rapid Integration of Information Presented at 2019 ASCO Annual Meeting into Clinical Practice


OBR and MDoutlook are pleased to share excerpts from the most recent MDoutlook OncoPolls™ following this year’s ASCO annual meeting in Chicago. This final report (from series of three releases with MDoutlook over the past week) highlights the three (3) oral presentations from Tuesday morning ASCO presentations concerning chronic lymphocytic leukemia (CLL). These presentations discussed the first-line use of Venetoclax + Obinutuzumab, the use of Acalabrutinib + Obinutuzumab in both the first-line and relapsed/refractory settings, and the CAR-T product Lisocabtagene maraleucel.

This research is based on separate, identical surveys conducted with US and EU5-based oncologists who treat CLL. The full complimentary report is available through MDoutlook.

OncoPoll™ Methodology

  • Primary research surveys were sent to verified and validated oncologists with an identified clinical interest in CLL and other B-cell lymphomas utilizing targeting parameters within the proprietary MDoutlook®global cancer treater and expert panel
  • Timing: June 2019. Launched shortly after close of 2019 American Society of Clinical Oncology (ASCO) Annual Meeting, held in Chicago, IL., May 31-June 4, 2019
  • Fielding via interactive web-based survey instruments, utilizing proven MDoutlook methodology and proprietary technology
  • Links to discussed abstracts on the ASCO website were provided within the survey
  • Responses: 100 total, 50 US and 50 EU5 oncologists. Overall, 51 respondents were at academic centers (16 US | 35 EU5) and 49 community-based practitioners (34 US | 15 EU5)

Abstract #7502: Venetoclax plus Obinutuzumab as a 1st line treatment for CLL

Key Conclusions about Abstract #7502 (Venetoclax + Obinutuzumab in first-line CLL)

  • Moderately high level of awareness about this presentation, especially among academics
    • Overall, only 9% of respondents had no awareness about this Abstract
  • After reviewing the abstract, respondents perceive a high improvement in efficacy of this regimen compared to other currently available treatments
    • The safety & tolerability and the administration / dosing schedule (fixed duration treatment) are also seen as advantages for this regimen
      • Although some concern was expressed by European community oncologists over the safety & tolerability issues

Abstract #7500: Acalabrutinib plus Obinutuzumab for 1st line CLL and r/r CLL

Key Conclusions about Abstract #7500 (Acalabrutinib + Obinutuzumab in untreated and r/r CLL)

  • A moderate level of awareness about this Abstract is present, more in academics than community and slightly higher in EU5 than in US
  • Remarkable consistency in the ratings of the efficacy and safety & tolerability profiles for this regimen in both the front line and relapsed / refractory setting
    • Efficacy ratings are slightly better than the safety & tolerability ones
    • Overall, the ratings are pretty consistent between US and EU5 oncologists

Abstract #7501: Lisocabtagene Maraleucel (Liso-Cel) in r/r CLL

Key Conclusions about Abstract #7501 (Liso Cel in r/r CLL)

  • As with Abstract #7500, a moderate level of awareness about this Abstract is present, more in academics than community and slightly higher in EU5 than in US
  • In terms of the efficacy outcomes, this CAR-T cell treatment has an even higher level of excitement than Acalabrutinib + Obinutuzumab in the r/r setting
    • Even with the potential toxicities seen with on the CAR-T cell approaches, the safety & tolerability of Liso Cel in this setting appears to be no worse / slightly better than other currently available approaches

Expected Integration of New ASCO Data into Clinical Practices

Key Conclusions about Integration of New ASCO Data into Clinical Practice

  • None of these 3 treatment regimens are regularly used in CLL (Venetoclax + Rituximab and Acalabrutinib alone are) (see the full MDoutlook report for current treatment details)
  • For future 1stline treatments:
    • Even with the strength of the new data presented, just over half (54%) of all treatment decisions will stay the same as today
    • While Obinutuzumab with either Acalabrutinib or Venetoclax will be used as an initial treatment, U S oncologists will favor using Acalabrutinib while EU oncologists will favor using Venetoclax
  • For future 2ndline treatments:
    • These three regimens are expected to comprise the majority of 2ndline treatments, especially in academic settings
    • Academics in both the US and EU will integrate Liso Cel as early as the 2ndline, at least in selected patients (up to 20%)
  • For future 3rdline treatments:
    • As with the 2ndline, most (57%) of treatments are expected to involve one of these three regimens
    • Liso Cel will be the top treatment in the 3rdline, with community-based oncologists willing to refer for it if the CLL patient progresses this far

Overall Conclusions: Immediate Impact of 2019 ASCO Presentations on the Clinical Practice for CLL

  • Even though the CLL Oral Abstract presentations were not until the very end of ASCO, it did not appear to dampen the awareness or enthusiasm for these presentations
    • EHA (European Hematology Association annual congress, Amsterdam 14thto 16thJune 2019) following 2 weeks later as a “reinforcement” / expansion of new data probably helped contribute to this
  • Acalabrutinib + Obinutuzumab, Venetoclax + Obinutuzumab, and the CD19-targeted CAR-T cell product Liso Cel are all positively viewed and eagerly awaited as standard treatment options for patients with CLL
  • Identification of specific patient populations for these and current treatment regimens, including older ones like FCR, and a better understand of the optimal sequencing of these various treatment regimens is needed

For a more detailed analysis report, please click here to visit MDoutlook or click here to obtain this report.

Submitted by Robert Stephan, SVP, Research & Operations and Jan Heybroek, President, MDoutlook.

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