Dr Adam Olszewski on Growing Ibrutinib Use to Treat CLL

Ibrutinib quickly became the de fact standard of care to treat chronic lymphocytic leukemia, but the high price presents a problem for the US healthcare system, said Adam Olszewski, MD, associate professor of medicine at The Warren Alpert Medical School of Brown University.

Transcript

Why did first-line use of ibrutinib grow so quickly and how has the system handled that?

Arrival of ibrutinib has been something that has been waiting for a very long time, and clinicians and patients had really high hopes for it. And to a large extent, these hopes have been realized. There are multiple clinical trials within the past year or 2 demonstrating significantly improved outcomes, particularly in terms of progression-free survival with ibrutinib over traditional chemotherapy, which were not that easy to deliver for older patients anyway.

When we look at treatment patterns, and over the past 10 years, it seems that the chlorambucil—obinutuzumab treatment, which had been also shown to be a significant advance over some historical standards actually never kicked off in the United States as a widespread therapy. So, I think the promise of oral therapy without the name chemotherapy attached to it and without the typical side effects were expected, were a really major game changer for most older patients, and we can definitely see it in the real-world data immediately after approval of ibrutinib. Even though this approval was initially quite restricted to patients with 17p deletions and high-risk CLL, really exploded very rapidly and spending on ibrutinib in 2016 already exceeded spending on all the other drugs for CLL. And I'm sure over the past 2 years, as ibrutinib got approved for all patients in the first-line therapy, this will further increase.

So, how will the system handle it? I think it has becoming a problem. The United States relies on the system of very complicated arrangements between drug manufacturers, pharmacy benefit managers, consumers, and I think we will have to seriously think about how these expensive treatments in hematology will be paid for and what kind of contracting and system-wide changes we have to make to do it, because it's clearly becoming unsustainable when every new drug is priced a little bit further down or up on the on the ladder of how much the market can take.

But you know, right now, I think ibrutinib has become the de facto standard of care in the United States as we can see from the data and this will be the reality.