In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 35, No. 15_suppl ( 2017-05-20), p. 7525-7525
Abstract:
7525 Background: Cardiovascular (CV) complications associated with ibrutinib (Ibr) include hypertension (HTN) and atrial fibrillation (AFIB) (incidence 26% and 9%, OBrien, ASH 2016). Unlike clinical trials, Ibr toxicities are the most common reasons for its discontinuation in clinical practice. The incidence of HTN in pts treated with Ibr outside of clinical trial setting and its impact on outcomes is unknown. Methods: Retrospective, cohort study of Ibr-treated CLL pts to estimate HTN incidence. Baseline CLL characteristics and co-morbidities were recorded. Blood pressure (BP) measurements were recorded prior to Ibr and sequentially following exposure at specific time points. CV meds were reviewed during a 12 mo follow-up period. The association between Ibr exposure and BP was tested. Results: 153 consecutive CLL pts treated with Ibr at a dose of 420 mg/day were identified. Med age was 57 yr (range: 34-87), relapsed CLL (69%), follow-up 14.5 mo. CV pre-Ibr characteristics included: smoking hx (49%), HTN (42%), hyperlipidemia (39%), diabetes (17%), CAD (12%), AFIB (6.8%). Proportion of pts on ≥1 anti-HTN med increased from 44% pre-Ibr (20% ≥ 2) to 57% during Ibr (30% ≥ 2). Med pre-Ibr BP was 127/70 mmHg (range 90-182/48-95mmHg). At 1, 3, 6, 9, 12 mo, med BPs were 137/73, 141/75, 143/76, 140/75, 142/77 (7 mo to peak BP). There was a significant association between Ibr exposure and increased BP (p 〈 .01). New HTN was observed in 40% of pts and 36% HTN pts had BP increased above baseline (med baseline 135/70 vs peak 161/80). Incidence of new AFIB was 8.1%. In UV analyses, predictive clinical factors for HTN were not identified. Pre-Ibr HTN (OR 3.0, p .05), CAD (OR 4.3, p .03), prior AFIB event (OR 10.8, p.001), hyperlipidemia (OR 3.4, p.05) were associated with post-Ibr AFIB. Conclusions: In the largest real-world series focused on BP in Ibr treated pts, we demonstrate a clear association between Ibr and HTN. Nearly 40% of pts developed HTN within 12 mo of Ibr exposure (vs. 26% in clinical trials over 5 yr). Despite aggressive management (multiple agents), Ibr associated HTN was persistent. These data underscore the critical need for monitoring and management strategies for HTN and follow-up data on future CV events.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/JCO.2017.35.15_suppl.7525
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2017
detail.hit.zdb_id:
2005181-5
Bookmarklink