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Kevin L Obholz
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MA18 - Modelling, Decision-Making and Population-Based Outcomes (ID 920)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 13:30 - 15:00, Room 201 F
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MA18.10 - Evolving Immunotherapy Practice Patterns in Advanced NSCLC: Analysis of an Online Treatment Decision Tool (ID 13848)
14:30 - 14:35 | Author(s): Kevin L Obholz
- Abstract
- Presentation
Background
Checkpoint immunotherapy (IO) is revolutionizing NSCLC therapy. We have previously published results of an online decision support tool designed to provide clinicians with education and expert guidance (Chow et al: JTO 2015). Here we report an analysis of a recently updated version of this online tool, capturing the impact of emerging IO options.
a9ded1e5ce5d75814730bb4caaf49419 Method
From June 2016 to July 2017, the NSCLC decision tool was updated to incorporate new treatment options for 280 different case scenarios. Briefly, oncologists entered patient and disease characteristics and then their planned treatment into the tool. Afterwards recommendations from 5 lung cancer experts were provided for that specific patient scenario.
4c3880bb027f159e801041b1021e88e8 Result
This analysis includes 1481 individual cases entered by 863 practicing oncologists between June 2016 and April 2018 (USA 19%, Europe 33%, Rest of World 48%). During this time, treatment choices for EGFR and ALK cancers by oncologists closely resemble those of experts. After approval of 1st-line pembrolizumab for patients with high PD-L1 expression, oncologists recommended pembrolizumab less often than experts (67% vs 95%). In the 2nd-line setting following platinum chemotherapy, both tumor histology and PD-L1 expression level impacted treatment recommendations (see Table). For PD-L1 expression < 1%, recommendations between oncologists and experts differed substantially.
Second-line setting after platinum chemotherapy Participants' Treatment Choice Experts' Treatment Choice 2016 2017 2016 2017 Nonsquamous PD-L1 (≥ 1%) 54% IO
34% CT
(n = 35)
79% IO
15% CT
(n = 47)100% IO
85% IO
15% CT
PD-L1 (< 1%) 28% IO
65% CT
(n = 104)49% IO
41% CT
(n = 63)40% IO
55% CT
75% IO
25% CT
Squamous PD-L1 (≥ 1%) 62% IO
25% CT
(n = 24)74% IO
4% CT
(n = 23)100% IO
100% IO
PD-L1 (< 1%) 28% IO
65% CT
(n = 74)
38% IO
40% CT
(n = 45)
85% IO
15% CT
80% IO
20% CT
This updated analysis of an online NSCLC decision-making tool integrates recent changes to the treatment landscape in 2017, capturing emerging patterns in IO therapy. Compared to earlier versions, practicing oncologist’s choice of 1st-line EGFR- and ALK- targeted therapy more closely tracked with experts during this period, while selection of IO differs from expert recommendations. A detailed analysis of expert versus online user data will be presented.
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