Older Patients With DLBCL Face Poor Overall Survival, High Costs With R-GemOx Treatment

Elderly patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) that were treated with the combination of rituximab, gemcitabine, and oxaliplatin (R-GemOx) had poor overall survival rates, faced a substantial economic burden, and had high rates of health care resource utilization (HCRU) in a study published in Clinical Lymphoma, Myeloma & Leukemia.

Treating elderly patients with DLBCL poses difficulties, as standard-of-care therapies are not always preferred for this population. Advanced age can be further limiting on therapeutic options for R/R DLBCL.

R-GemOx is one of the most widely used therapies among individuals with R/R DLBCL who are ineligible for a stem cell transplant. Despite this, there has been little real-world evidence published on the treatment regimen, specifically in older adults.

IV drug administration | Image credit: Sherry Young - stock.adobe.com

Given the importance of understanding unmet needs and economic burden in patients with DLBCL treated with R-GemOx, the investigators conducted a retrospective analysis of elderly R/R DLBCL patients to analyze overall survival (OS), HCRU, and accumulated costs throughout treatment.

In total, the final sample included 157 patients who had received treatment with R-GemOx in the R/R setting. The mean age was 77.5 years (SD, 6.0 years), and 39.5% of patients were at least 80 years old, the investigators found.

The median overall survival from R-GemOx initiation in the 2L setting was 6.9 months, while it was 6.8 months in the 3L setting. The 1-year survival rate from R-GemOx initiation was 38.2% for 2L patients and 37.0% for 3L patients, according to the investigators.

The investigators found substantial HCRU within 12 months of R-GemOx treatment initiation. In the 2L setting, 68.1% of patients had evidence of an all-cause hospitalization, and 42.9% had indications of hospice use within 12 months of initiating R-GemOx. In the 3L setting, over 90% of patients had evidence of all-cause hospitalization, and over half (51.7%) showed evidence of hospice use.

Health care costs in the 2L and 3L setting within 12 months of beginning R-GemOx treatment were also analyzed. All-cause total costs were $144,653 and $142,812 within 12 months of treatment initiation in the 2L and 3L setting respectively, the investigators found.

In both the 2L and 3L settings, approximately 79% of health care costs were DLBCL-related ($114,541 and $142,812, respectively). Among patients who began R-GemOx treatment in the 2L setting, DLBCL-related medical costs ($80,289) were responsible for 70% of DLBCL-total costs, and were more than double the cost of DLBCL-related drugs ($34,252), according to the investigators.

There was a similar pattern observed in the 3L setting within 12 months of treatment initiation, though drug costs were lower ($26,450) and medical costs were higher ($86,440) in comparison to the 2L setting.

To the investigators' knowledge, this was the first real-world study analyzing the HCRU, survival, and costs among elderly patients initiating R-GemOx treatment for R/R DLBCL. They noted that their results can provide key observations on the unmet needs in this patient population and provide a better roadmap for patient outcomes.

Most notable among their findings was the discovery that R-GemOx treatment is not currently sufficient for many elderly patients with DLBCL. This was underscored by the relatively short time to next treatment for patients, as those in the 2L setting began a new treatment less than 3 months on average after ending R-GemOx therapy, the investigators discussed.

“Our study results suggest a large unmet need and underscore the importance of newer, more efficacious agents with manageable tolerability profiles that can be used in combination or as an alternative to R-GemOx for elderly patients with R/R DLBCL,” the investigators concluded.

Reference

Garg M, Puckett J, Kamal-Bahl S, et al. Real-world survival, healthcare resource utilization, and costs among U.S. elderly patients with diffuse large B-cell lymphoma (DLBCL) treated with R-GemOx in the relapsed/refractory setting. Clin Lymphoma Myeloma Leuk. Published online February 8, 2024. doi:10.1016/j.clml.2024.01.010