This retrospective cohort followed 584 US community oncology patients starting first-line covalent BTK inhibitors for CLL/SLL, 2019 to 2023. Electronic health records and chart abstraction showed 384 took ibrutinib, 150 acalabrutinib and 50 zanubrutinib; median age was 73. By 24 months 51.2% had discontinued, and 65.9% by end of follow-up, most often for adverse events (38.4%). Of those who stopped, 61.8% did not start second-line therapy. Acalabrutinib was linked to longer time on treatment than ibrutinib (HR 0.61), and 24-month overall survival was 81.9%. Records may be incomplete, and the zanubrutinib group was small, with median follow-up of 16.1 months.
Why it is interesting: Median time on first-line therapy was 23 months, far shorter than in the trials. Many who stopped then went without further treatment for some time, as median time to next treatment or death was 48 months.
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