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P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Presentations: 1
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
P3.01-57 - Real-World (RW) Predictors of Immuno-Oncology (IO) vs Chemotherapy (C) Use in Advanced Non-Small Cell Lung Cancer (aNSCLC) (ID 13002)
12:00 - 13:30 | Presenting Author(s): Bruce Feinberg
For patients with aNSCLC without known mutations, demographic and clinical characteristics may impact second-line (2L) treatment decisions. Describing predictors of 2L RW drug utilization may help optimize outcomes of patients with aNSCLC who eventually progress. This study evaluated predictors for 2L IO vs. C use in patients with aNSCLC treated with 1L C (proxy for patients without treatment-altering mutations).a9ded1e5ce5d75814730bb4caaf49419 Method
A retrospective cohort of continuously enrolled adult patients with lung cancer initiating 1L C ≤6 months of diagnosis was identified from Inovalon’s MORE2 Registry® claims post IO approval in lung cancer (Mar 2015 - Dec 2016). Patients receiving 2L systemic therapy following 1L C were selected, excluding patients with SCLC, treated for secondary malignancies, with <1 month follow-up, or on clinical trials. The influence of baseline characteristics on choice of 2L IO vs C was evaluated using binary multiple logistic regression (LR), excluding targeted therapy (TT) due to small sample. Odds ratio (OR) >1 indicated greater chance of IO use. P-value <0.05 was considered significant.4c3880bb027f159e801041b1021e88e8 Result
Of 2,700 patients initiating 1L C, 829 (31%) received 2L: 539 (65%) received C, 262 (32%) IO, 28 (3%) TT. By subgroup (C, IO, TT), 46%, 54%, 57% (p=0.055) were female; mean age at 2L start was 65.3, 66.0, 61.0 years (p=0.045); Charlson comorbidity index: 2.8, 2.0, 1.5 (p=0.001); lines of therapy per patient: 2.4, 2.3, 2.5 (p=0.012); comorbidity count: 1.5, 1.1, 0.7 (p<0.001); follow-up from 1L start: 11.3, 10.9, 11.6 months (p=0.499); 18%, 26%, 21% (p=0.028) commercially insured; 70%, 68%, 39% (p=0.003) had evidence of smoking cessation/ counselling; 30%, 13%, 11% (p<0.001) had evidence of another malignancy at diagnosis; and 7%, 3%, 0% (p=0.032) had evidence of diabetes with chronic complications at diagnosis.
LR model showed factors increasing likelihood of 2L IO use included evidence of chronic obstructive pulmonary disease (COPD) at diagnosis (OR=1.54, p=0.025), longer time to 1L discontinuation (1.27, p<0.001), and commercial insurance (2.29, p=0.001). Factors negatively impacting IO choice were: 1L combination therapy use (0.48, p<0.001), evidence of secondary malignancy at diagnosis (0.21, p=0.001), and evidence of diabetes with chronic complications at diagnosis (0.33, p=0.031).8eea62084ca7e541d918e823422bd82e Conclusion
This retrospective RW study showed that aNSCLC patients with COPD, longer 1L treatment, on 1L monotherapy, and private insurance are more likely to receive 2L IO vs C. As such, early consideration needs to be given in order to monitor these patients more closely.6f8b794f3246b0c1e1780bb4d4d5dc53
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