Latino Patients Less Likely to Receive Guideline-Recommended CLL Therapies

Photo Credit: Nemes Laszlo

In this video, Adam Kittai, MD, discusses his team’s analysis presented at the 2025 ASCO Annual Meeting, which identified disparities in therapy access among Latino patients with chronic lymphocytic leukemia (CLL). The study was funded by BeOne.

VIDEO TRANSCRIPT:

My name is Adam Scott Kittai. I am an associate professor at the Icahn School of Medicine at Mount Sinai, where I’m the CLL Clinical Research Leader.

What inspired your research into CLL treatment access disparities, and what were your key findings?

Previously, we published two population-based studies looking at racial disparities in CLL. First, we looked at SEER data and found that patients who were of racial minorities had worse overall survival compared to White patients with CLL, even in the modern era of therapies. We then analyzed the Flatiron data, which is real-world data, and found that patients who were Black had equal survival as patients who were White and were treated with equal amounts of ibrutinib, one of our targeted agents.

The Flatiron data, which is very different than the SEER data, represents patients who had access to an oncologist. It reflects a different patient group than the US as a whole. So a follow-up question that we had was whether patients of minority groups were less likely to receive recommended therapy over time compared to White patients. We looked at uptake of novel agents over time by dividing changes in the NCCN guidelines based on when they were updated to add new therapies such as ibrutinib, acalabrutinib, zanubrutinib, and venetoclax. We looked at whether minority patients were less likely to get these recommended therapies as they were added to the NCCN guidelines.

We found that patients who were Latinx were significantly less likely to receive recommended therapies compared to White patients. Similar to prior data that we published, Black patients were as likely to get recommended therapies as White patients.

We then looked at how fast prescribing habits changed as the NCCN guidelines recommended drugs changed, and we found that academic centers were faster to adopt NCCN-preferred treatments than community practices.

Interestingly, there was also rapid adoption of ibrutinib when it was approved based on the A041202 study, but the utilization of second generation BTK inhibitors like zanubrutinib was a bit slower.

All of this tells us that although access to an oncologist mitigates disparities between White and Black patients, that doesn’t necessarily hold true for members of all racial minority groups. Follow-up questions include prescribing habits nationwide, in areas of lower socioeconomic status as well as areas of higher racial diversity. I think it is an access issue, and as we’ve seen here, recapitulating prior data, having access does diminish a lot of the disparity but not all of it.

What barriers prevent patient access to new treatments when guidelines are updated?

Barriers to faster adoption is a very complex question. Recently, we did a SEER analysis looking at all hematologic malignancies, and we found that diseases with higher relative survival rates had a wider disparity in treatment. This means that when diseases have good treatments available, a wider disparity occurs. I think this disparity is likely due to cost, lack of good insurance, and patients being unwilling to take the newest thing available, preferring to go with the tried-and-true treatment. There may be a cultural issue, and there also could be prescriber bias. It’s a complex issue that requires more detailed study, and we don’t know yet why exactly these disparities occur.

What advice do you have for other oncologists seeking to help close these gaps?

One of the things that I encourage everybody to do is to not just assume that a patient’s insurance will not cover the NCCN guideline-preferred agent. Always give it a shot.

I have also tried prescribing one preferred agent, and if it wasn’t covered, I tried prescribing another preferred agent. I’ve changed what I prescribe in hopes that the insurance company will cover it. We don’t have good phase 3 data to say that any of these agents should be preferred over one another, meaning that we don’t know if second generation BTK inhibitors given continuously are better than a venetoclax regimen just yet. So I think we have justification to use a variety of regimens in different scenarios.

Another avenue that people can take to mitigate cost is reaching out to the drug companies. Oftentimes, you can get coupons. There are also various grants available through the Leukemia & Lymphoma Society and the Lymphoma Research Foundation. I encourage you to reach out to them to get these drugs covered for your patients.

Once again, I think we all need to not assume that a patient wouldn’t want a certain therapy, and make sure that we are open and performing shared decision making with all patients that come into our clinics.

What are the next steps in your research? Do you see opportunities for intervention aimed at reducing these disparities?

In this research, we have identified and hardened that access is the issue. Unless we attack this access issue with our full might, we’re not going to make much of a difference. To improve these disparities, we need governmental change to get people access to specialty care. Without access, people aren’t even being exposed to preferred agents that have made such an impact on our patients with cancer. I think intervention needs to be top-down.

What we can do as doctors is increase our access to patients by opening clinics and conducting trials where they live. To get patients onto drugs that may require some extra monitoring (like venetoclax ramp up) or get patients into new clinical trials that have revolutionized the way we treat patients with CLL, we need to meet them where they are. We need to have these things available to where they live. It shouldn’t require them to commute over an hour to get to the local oncologist’s office or the academic center.

Ultimately, this has to come top-down from governmental regulations, but if there is one thing that we can do in our own practices, it is to attempt to bring these trials and drugs to patients the best that we can.

This transcript has been edited for readability.

Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Physician’s Weekly, their employees, and affiliates.