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Melissa Pavilack
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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 | Presenting Author(s): Melissa Pavilack
- Abstract
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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P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.16-37 - Impact of Brain Metastases on Healthcare Utilisation and Costs in Patients with NSCLC Treated with EGFR-TKIs (ID 1970)
10:15 - 18:15 | Author(s): Melissa Pavilack
- Abstract
Background
NSCLC with brain metastases is difficult to treat and associated with poor survival. The impact of brain metastases compared with other metastases on healthcare utilisation and costs among patients treated with EGFR-TKIs is not well known.
Method
Newly-diagnosed adult patients with metastatic NSCLC initiating approved first-/second-generation EGFR-TKI treatment (within 90 days of diagnosis) were identified retrospectively from IBM Watson Health MarketScan® healthcare claims databases from 2013–2017. Patients were divided into mutually-exclusive cohorts based on evidence of brain or non-brain metastasis (BM or NBM). Demographics, clinical characteristics and healthcare expenses were captured at baseline. Healthcare utilisation and cost were analysed during the variable-length follow-up period. Costs were standardised to 2017 US$ and reported as per-patient-per-month (PPPM). Generalised linear models were used to assess the impact of brain metastases, adjusting for baseline demographics, comorbidities, healthcare expenses and length of follow-up.
Result
Overall, 222 BM and 280 NBM patients were included. BM patients were, on average, younger than NBM patients (59.9 vs 65.7; p<0.05); both cohorts included mostly female patients and had an average of 14 months follow-up. Among all patients, first EGFR-TKI treatment was 82.3% erlotinib, 16.3% afatinib and 1.4% gefitinib; 10 patients treated with osimertinib were excluded. Seizures (9.0% vs 1.1%), headaches (17.6% vs 10.0%) and altered mental status (11.3% vs 5.7%) were more common in the BM vs NBM cohort (p<0.05). NSCLC-related healthcare utilisation was >2-fold higher in BM patients receiving radiation treatment in the inpatient (15.3% vs 6.8%; p<0.05) and outpatient (87.8% vs 37.5%; p<0.05) settings. PPPM radiation costs were also higher among BM patients in the inpatient ($796 vs $464, p=0.172) and outpatient ($2477 vs $762, p<0.05) settings. All-cause inpatient admissions were more common among the BM vs NBM cohort (67.1% vs 57.1%; p<0.05). While all patients had evidence of outpatient services, the PPPM number of outpatient visits was greater among the BM vs NBM cohort (p<0.05) for both NSCLC-related (5.1 vs 4.2) and all-cause (6.4 vs 5.7) healthcare utilisation. Adjusted NSCLC-related and all-cause PPPM costs were 1.2 times higher among BM patients (+$5674 and +$6393, respectively; p<0.05); age was also a significant predictor in both models (p<0.05).
Conclusion
Healthcare utilisation, hospital admission rates and costs, especially those attributable to radiation treatment, were higher among patients with BM compared with NBM. Future research should assess if central nervous system (CNS)-active EGFR-TKIs have the potential to reduce healthcare utilisation and costs associated with brain metastases.
