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Janet L. Espirito



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    P1.14 - Targeted Therapy (ID 182)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Targeted Therapy
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.14-18 - ALK Inhibitor Sequencing and Outcomes Among ALK-Positive (ALK+) NSCLC Patients in the US Community Oncology Setting (ID 731)

      09:45 - 18:00  |  Author(s): Janet L. Espirito

      • Abstract
      • Slides

      Background

      Several ALK inhibitors, including 2nd and 3rd generation agents are available for patients with ALK+ NSCLC. Treatment patterns and outcomes with use of multiple sequential ALK inhibitors is limited.

      Method

      A retrospective observational cohort study of patients with ALK+ NSCLC treated with 1st generation (crizotinib) and 2nd generation (alectinib, brigatinib, ceritinib) ALK inhibitors from 1 September 2011 to 31 December 2017. Structured data were obtained via programmatic extraction from the iKnowMed EHR database of the US Oncology Network. Patient demographics and treatment sequences were characterized. Index was the start date of the first ALK. Duration of therapy (DOT) from index to end of the last ALK, and overall survival (OS) were assessed using the Kaplan-Meier method.

      Result

      A total of 410 ALK+ NSCLC patients were included. Median age at index was 62 years, 54% were female, 78% Caucasian, 87% adenocarcinoma histology, and 54% never smokers. 233 (57%), 144 (35%), and 33 (8%) patients received 1, 2, or 3-4 different ALK inhibitors, respectively. Crizotinib monotherapy (50%) was most common. Among patients that received 2 or more ALK inhibitors (n=177), most were crizotinib-led sequences. In 59% of patients, chemotherapy was given prior to the first ALK (median time from start of chemo to index 6.64 mo), and 53% of patients ended their ALK sequence and received subsequent chemo. Median cumulative ALK DOT in the full study population, regardless of line of therapy or sequence was 16 mo (95% CI 6-19). Median OS from index for the full study population was 28 mo (95% CI 24, 36). Median OS among patients who received 1, 2, or 3-4 ALK inhibitors was 15 mo (95% CI 10, 22), 42 mo (95% CI 38, 60) and 56 mo (95% CI 31, 72).

      Conclusion

      Patients received a range of 1 to 4 ALK inhibitors. Crizotinib-led sequences were most common, likely reflecting the approval history of ALK inhibitors during the study period. Longer DOT and OS were observed in patients receiving multiple ALK inhibitors. This study provides an initial view of treatment patterns following the emergence of new ALK inhibitors and suggests feasibility of sequential ALK therapies. Follow-up studies will help improve understanding of outcomes of patients treated with 2nd generation-led sequences.

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    P1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 186)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.16-36 - Treatment Patterns Among Patients with EGFRm NSCLC Treated in the US Community Oncology Setting (ID 1582)

      09:45 - 18:00  |  Author(s): Janet L. Espirito

      • Abstract
      • Slides

      Background

      Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) therapy is associated with improved outcomes in patients with EGFR mutation-positive (EGFRm) non-small cell lung cancer (NSCLC). Despite initial responses, most patients develop resistance. Little is known about treatment following first-line (1L) TKIs. This study aimed to understand real world treatment patterns, T790M testing rates, and disposition of EGFRm patients following availability of newer TKIs.

      Method

      Adult patients with EGFRm stage IV NSCLC treated between Dec 1, 2015 and Aug 31, 2017, were retrospectively identified from the US Oncology Network’s iKnowMedSM (iKM) electronic health record. Patient characteristics, treatment patterns, and T790M testing data were obtained via programmatic database abstraction and supplemented with chart review.

      Result

      308 patients were identified during the study period. Median age at diagnosis was 69 years, 67% were female, 63% Caucasian, 49% never smokers and 59% with ECOG performance status 0–1. Nearly all patients (n=302; 98%) received treatment with a TKI, 80% (n=246) with a TKI as 1L therapy. The most frequently used TKIs as 1L monotherapy were erlotinib (n=204; 66%), afatinib (n=27; 9%), and gefitinib (n=3; 1%). Combination chemotherapy with or without a TKI was used in 24% of patients. Among all patients treated with a 1L TKI, 19% (n=47) were tested for the T790M mutation after 1L TKI, and 34% (n=16) were positive. The most common 2L therapies in patients who received a 1L TKI (n=44 patients) were pemetrexed-based chemotherapy (n=20; 45%), afatinib (n=7; 16%), and osimertinib (n=7; 16%). Among all patients who received a 1L TKI, 15% (n=41) had died, 18% (n=51) were still alive and on TKI therapy, 12% (n=29) went on to receive subsequent therapy, and 53% (n=149) stopped their TKI and received no subsequent therapy at the end of the follow-up period.

      Conclusion

      The majority of patients with EGFRm advanced NSCLC received 1L TKI therapy, most often with erlotinib. Following 1L TKI, less than 20% of patients were tested for T790M, and most did not receive any subsequent therapy following TKI. As understanding of resistance mechanisms in mutation-driven lung cancer is rapidly evolving, and as ongoing studies evaluate optimal treatments, it is imperative to integrate this information into clinical practice.

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    P2.06 - Mesothelioma (ID 170)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Mesothelioma
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.06-04 - Treatment Patterns and Outcomes of Advanced Malignant Pleural Mesothelioma (MPM) Patients in a Community Practice Setting (Now Available) (ID 723)

      10:15 - 18:15  |  Author(s): Janet L. Espirito

      • Abstract
      • Slides

      Background

      MPM is an aggressive neoplasm with a poor prognosis and limited therapeutic options. Pemetrexed+platinum is standard of care (SOC) for advanced MPM in the United States with cisplatin doublet as the only approved first-line (1L) treatment by the Food and Drug Administration (FDA). There are no FDA approved treatments in second-line (2L) or later. Understanding how patients are currently treated and the associated outcomes is important to assess the unmet needs in MPM.

      Method

      Retrospective data were abstracted from the US Oncology Network’s iKnowMed electronic health record (EHR) for patients with advanced MPM receiving systemic therapy between 01-Jan-2008 and 31-Dec-2016, followed through 31-Dec-2017. Eligibility criteria: ≥18 years of age, ≥2 visits, no clinical trial enrollment or other malignancy during study period. Baseline demographic/clinical characteristics, treatment patterns, duration of chemotherapy (DOT) and overall survival (OS) were assessed, using Kaplan-Meier methods for 1L, 2L+ survival.

      Result

      474 advanced MPM patients receiving treatment were identified; median age was 72 years, majority were male (82%) with an Eastern Cooperative Oncology Group (ECOG) score of 0 to 1 (71%). Cisplatin+pemetrexed (n=194; 41%) and carboplatin+pemetrexed (n=175; 37%) were the most frequent 1L regimens, followed by pemetrexed monotherapy (n=51; 11%). Only 108 (23%) patients received 2L and 33 (7%) received 3L. The most common 2L regimens included monotherapies gemcitabine (n=40; 37%), pemetrexed (n=27; 25%), vinorelbine (n=9; 8%), and IO therapy (avelumab, nivolumab or pembrolizumab n=9; 8%). Median DOT was 2.7 months in 1L SOC and 1.7 months in all 2L regimens. Unadjusted median OS in patients 1L SOC was 14.0 months (95%CI, 11.6-17.0) with similar survival observed among cisplatin+pemetrexed (13.7 months; 95%CI, 10.8-18.5) and carboplatin+pemetrexed (14.2 months; 95%CI, 11.1-19.8); OS for 1L pemetrexed monotherapy (10.7 months; 95%CI,6.2-14.3). Unadjusted OS in 2L was 6.4 months (95%CI, 5.1-7.6) ranging from 3.4 months (95%CI, 2.7-6.5) with gemcitabine to 11.8 months (95%CI, 0.3-NR) with immunotherapies.

      Conclusion

      This real-world analysis of advanced MPM showed a majority of 1L patients received SOC pemetrexed+platinum based therapy, with carboplatin almost as common as cisplatin. The platinum agent paired with pemetrexed in 1L SOC did not affect unadjusted survival in the community setting. Less than a quarter of 1L patients received a 2L therapy, with gemcitabine as the most common treatment. Overall survival in MPM remains poor and treatment rates in 2L are low, highlighting the need for more effective therapies.

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