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Alisha Monnette
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FP02 - Health Services Research/Health Economics (ID 120)
- Event: WCLC 2020
- Type: Posters (Featured)
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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FP02.02 - Real-World Outcomes Among Advanced Non-Small Cell Lung Cancer Patients Re-Treated with Immunotherapy in the US (ID 3706)
00:00 - 00:00 | Author(s): Alisha Monnette
- Abstract
Introduction
Immunotherapy (IO)-based regimens (alone or in combination with chemotherapy) are the current standard of care for the first-line (1L) treatment of advanced non-small cell lung cancer (aNSCLC). However, many patients undergoing 1L IO progress and need subsequent treatment. Currently, there is limited information regarding outcomes for patients who receive subsequent treatment following 1L IO for aNSCLC. This real-world study aimed to assess treatment patterns and clinical outcomes among patients retreated with IO-based regimens as second-line (2L) therapy following 1L IO in a US community oncology setting.
Methods
A retrospective observational study was conducted to identify patients from the US Oncology iKnowMed database who received 1L IO-based therapy followed by 2L treatment for aNSCLC between October 1, 2016 and September 30, 2019. Data were collected up to March 31, 2020 to allow at least 6 months of potential follow-up for each patient. Clinical trial participants, those under the age of 18, or those treated for other primary cancer were excluded. Patients were determined to have transitioned from 1L to 2L therapy if there was a change in regimen (e.g., Pembrolizumab to Nivolumab), the addition of a new antineoplastic agent, or a gap of at least 90 days between treatments. Baseline patient characteristics were described, and treatment outcomes were estimated from 2L initiation (i.e., index date) using Kaplan-Meier methods.
Results
The study population included 490 patients: 30% (n=149) received IO-based 2L treatment while 70% (n=341) received non-IO 2L therapies. The three most common non-IO 2L therapies included chemotherapy (n=253), chemotherapy+targeted therapy (n=53), and targeted therapy (n=35). Prior 1L treatment patterns showed 56% (n=276) received 1L IO monotherapy, 40% (n=194) received 1L combination IO+chemotherapy, and 4% (n=20) received some other form of IO therapy (e.g., IO+IO). Key findings are reported in the table below.
TABLE 1: Patient Characteristics and Outcomes for Patients Initiating 2L Treatment
ConclusionIO-Based
Non-IO based
(n=149)
(n=341)
Patient Characteristics
Median Age at 2L Treatment Initiation (years)
70
69
Male (%)
53.7
52.5
No History of Smoking (%)
12.8
16.1
Squamous Histology (%)
22.2
15.5
ECOG Status (%)
0
12.8
15.5
1
57.1
53.7
2+
16.4
17.3
Not Available
14.8
13.5
PD-L1 (%)
<1%
11.4
16.7
1-49%
7.4
12.9
50%+
39.6
32.6
Not Available
41.6
37.9
Median 1L Treatment Duration (Months)
3.3
3.7
2L Treatment Outcomes
Median 2L Treatment Duration (Months)
4.5
2.5
Median Overall Survival (Months)
18.4
10.6
Patients who received IO or non-IO based therapies in 2L appeared similar, although a higher proportion of patients who received 2L IO retreatment had PD-L1 ≥50%. Retreatment with IO did not suggest to negatively affect outcomes, and unadjusted treatment duration and survival were longer in patients receiving 2L IO (p-value=0.02). Stratifications by 1L therapy (IO monotherapy and IO+chemotherapy) were consistent with the combined results reported below. Further study on the effects of 1L treatment duration and optimal duration of overall IO therapy are warranted.
