Ashwini Arunachalam

Real-world first-line treatment and overall survival in non-small cell lung cancer without known EGFR mutations or ALK rearrangements in US community oncology setting

Purpose To establish a baseline for care and overall survival (OS) based upon contemporary first-line treatments prescribed in the era before the introduction of immune checkpoint inhibitors, for people with metastatic non-small cell lung cancer (NSCLC) without common actionable mutations. Methods Using a nationally representative electronic health record data from the Flatiron dataset which included 162 practices from different regions in US, we identified patients (≥18 years old) newly diagnosed with stage IV NSCLC initiating first-line anticancer therapy (November 2012- January 2015, with follow-up through July 2015). Patients with documented epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) translocation were excluded. Anti-cancer drug therapy and overall survival were described overall, and by histology. Results A total of 2,014 patients with stage IV NSCLC without known EGFR or ALK genomic tumor aberrations initiated systemic anticancer therapy, 22% with squamous and 78% with nonsquamous histology. Their mean (SD) age was 67 (10) years, 55% were male, and 87% had a smoking history. In nonsquamous NSCLC, carboplatin plus pemetrexed either without (25.7%) or with bevacizumab (16%) were the most common regimens; 26.6% of nonsquamous patients receiving induction therapy also received continuation maintenance therapy. In squamous NSCLC, carboplatin plus paclitaxel (37.6%) or nab-paclitaxel (21.1%) were the most commonly used regimens. Overall median OS was 9.7 months (95% CI: 9.1, 10.3), 8.5 months (95% CI: 7.4, 10.0) for squamous, and 10.0 months (95% CI: 9.4, 10.8) for nonsquamous NSCLC. Conclusion The results provide context for evaluating the effect of shifting treatment patterns of NSCLC treatments on patient outcomes, and for community oncology benchmarking initiatives.

Systemic therapy treatment patterns in patients with advanced non-small cell lung cancer (NSCLC): PIvOTAL study

&NA; The aim of this multinational retrospective cohort study, conducted at academic and community oncology centres, was to describe real‐world treatment patterns for patients with a confirmed diagnosis of advanced/metastatic (stage IIIB/IV) non‐small cell lung cancer (NSCLC) who initiated first‐line systemic therapy from January 2011 through June 2014. The study included 1265 patients in Italy, Spain, Germany, Australia, Korea, Taiwan and Brazil. The proportion of patients with squamous versus non‐squamous NSCLC was approximately 20% versus 75%, and associated patient demographic characteristics were similar in all countries, excepting race. Patients with squamous NSCLC were predominantly male and current/ex‐smokers. Biomarker tests were performed for the majority of patients with non‐squamous NSCLC, ranging from 54% (Brazil) to 91% in Taiwan, where, of those tested, 68% with non‐squamous NSCLC had positive epidermal growth factor receptor (EGFR)‐mutation status; in other countries the EGFR‐positive percentages ranged from 17% (Spain/Brazil) to 40% (Korea). Platinum‐based regimens were the most common first‐line therapy in all countries except Taiwan, where gefitinib was the most common first‐line agent. Median overall survival ranged from 9.3 months (Brazil) to 25.5 months (Taiwan). The diagnostic and treatment patterns recorded in this study were heterogeneous but largely in line with NSCLC guidelines during the study period.

Real-world practice patterns for patients with advanced non-small cell lung cancer: multicenter retrospective cohort study in Japan

Background Recommended therapies for advanced/metastatic non-small cell lung cancer (NSCLC) have changed with the advent of targeted therapies. The objectives of this retrospective chart review study were to describe treatment patterns, biomarker testing practices, and health care resource use for advanced NSCLC at 5 sites in Japan. Patients and methods We studied anonymized medical record data of patients aged ≥18 years who initiated systemic therapy for newly diagnosed stage IIIB or IV NSCLC from January 2011 through June 2013. Data were analyzed descriptively by histology and mutation status. Overall survival was estimated using the Kaplan–Meier method. Results We studied 175 patients, including 43 (25%), 129 (74%), and 3 (2%) with squamous, nonsquamous, and unknown NSCLC histology, respectively; 83% had stage IV NSCLC. Overall, 123 patients (70%) were male; the median age was 70 years (range, 47–86); and 33 (19%) were never-smokers. In the nonsquamous cohort, 105 (81%) and 25 (19%) of patients were tested for epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement, respectively; 44 (42%) had EGFR-positive NSCLC and 2 (8%) had ALK-positive NSCLC, including 26/46 (57%) women and 21/46 (46%) never-smokers. In the squamous cohort, 17 (40%) and 4 (9%), respectively, were tested; 1 EGFR-positive tumor was detected. After first-line therapy, 105 (60%) patients received second-line, and 54/105 (51%; or 31% overall) received third-line therapy. EGFR tyrosine kinase inhibitors were most commonly prescribed for EGFR-positive NSCLC across all lines. In the nonsquamous EGFR/ALK-negative/unknown cohort, most received first-line platinum combinations, particularly younger patients (78% ≥75 years vs 93% <75 years old). The average hospitalization was 21 days/admission. The median (95% CI) overall survival from start of first-line therapy was 9.9 months (7.6–11.7) for all patients and 17.9 months (9.9–24.4) for patients with EGFR/ALK-positive status. Conclusion Biomarker testing is common for nonsquamous NSCLC at the 5 Japanese study sites. Treatment is personalized by mutation status and age, per guideline recommendations.

Real-World Treatment Patterns, Overall Survival, and Occurrence and Costs of Adverse Events Associated With Second-Line Therapies for Medicare Patients With Advanced Non–Small-Cell Lung Cancer

Micro‐Abstract: This Surveillance, Epidemiology, and End Results–Medicare analysis included 4033 patients receiving second‐line therapy after first‐line platinum‐based therapy for newly diagnosed stage IIIB/IV non–small‐cell lung cancer in the pre‐immunotherapy era (2007 to mid‐2013). Patients received a variety of second‐line agents, most commonly pemetrexed, docetaxel, carboplatin/paclitaxel, and gemcitabine. Dyspnea and anemia were the most common AEs. Mean total per‐patient–per‐month cost was

Real-World Treatment Patterns, Overall Survival, and Occurrence and Costs of Adverse Events Associated With First-line Therapies for Medicare Patients 65 Years and Older With Advanced Non–small-cell Lung Cancer: A Retrospective Study

10,885; and the prognosis was poor. Introduction: Real‐world data on current treatment practices for non–small‐cell lung cancer (NSCLC) are needed to understand the place in therapy and potential economic impact of newer therapies. Patients and Methods: This retrospective cohort study identified patients ≥ 65 years old in the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked database with first‐time diagnosis of stage IIIB/IV NSCLC from 2007–2011 who received second‐line therapy after first‐line platinum‐based chemotherapy from 2007 through mid‐2013. Second‐line regimens, health care resource use, adverse events (AEs), and associated costs were analyzed descriptively. Overall survival was determined by Kaplan‐Meier test. Costs were adjusted to 2013 US dollars. Results: We identified 4033 patients with advanced NSCLC who received second‐line therapy (47% of those who received first‐line platinum‐based chemotherapy). Mean (SD) age was 73 (5) years, 2246 (56%) were male; 1134 (28%) and 2899 (72%) had squamous and nonsquamous NSCLC, respectively. The 4 most common second‐line regimens were pemetrexed (22%), docetaxel (12%), carboplatin/paclitaxel (11%), and gemcitabine (7%). Median overall survival from second‐line therapy initiation was 7.3 months (95% confidence interval, 7.0–7.7). Dyspnea and anemia were the most common AEs of interest, affecting 29% and 26% of patients, respectively; atypical pneumonia was associated with the highest AE‐related costs (mean,

Molecular testing and treatment patterns for patients with advanced non-small cell lung cancer: PIvOTAL observational study

5339). The mean total per‐patient–per‐month cost was

First-line treatment of metastatic NSCLC (mNSCLC) patients without actionable mutations in U.S. community oncology clinical practice.

10,885; AE‐related per‐patient–per‐month costs totaled

Health care resource use among patients with advanced non-small cell lung cancer: the PIvOTAL retrospective observational study

1036 (10%). Costs were highest for pemetrexed‐treated patients. Conclusion: These real‐world data illustrate the variety of second‐line regimens, poor prognosis, and high cost of second‐line chemotherapy for patients with advanced NSCLC treated before the approval of immunotherapies for these patients.

Utilization and Treatment Patterns Among Patients with Advanced Non-Small Cell Lung Cancer Receiving Predictive Molecular Biomarker (BMX) Tests

Micro‐Abstract: This SEER‐Medicare database analysis (n = 5931) for first‐line platinum‐based therapy of stage IV NSCLC describes real‐world treatment patterns (2007 to mid‐2013) by histologic subtype, adverse events (AEs), and associated costs. Carboplatin‐doublets were most commonly prescribed; dyspnea/anemia were the most common AEs; mean per‐patient‐per‐month cost was

P1.06-021 Treatment Patterns and Healthcare Resource Use from a Retrospective Cohort of Japanese Patients with Advanced Non-Small Cell Lung Cancer: Topic: Advanced General

11,909. Our findings confirm and expand previous study results regarding the AE‐related costs of therapy by treatment regimen. Purpose: This study sought to better understand real‐world treatment patterns, overall and non–small‐cell lung cancer (NSCLC)‐specific survival, adverse event (AE) occurrence, and economic impact of first‐line cancer therapies in Medicare patients. Patients and Methods: This retrospective cohort study identified patients ≥ 65 years in the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked database who received a first‐time advanced (stage IV) NSCLC diagnosis from 2007 to 2011, and who received first‐line platinum‐based chemotherapy from 2007 through mid‐2013. First‐line regimens, healthcare resource use, occurrence of AEs, and associated costs (2013 US dollars) were analyzed. Median survival was determined using the Kaplan‐Meier method. Results: Surprisingly, only 46% of patients (n = 13,472) with stage IIIB/IV NSCLC received systemic therapy, and 5931 received platinum‐based therapy. The mean age was 73 years, with 3354 (57%) males; 1489 (25%) had squamous and 4442 (75%) nonsquamous histology. The most common regimens were carboplatin doublets (70%), including carboplatin/paclitaxel (38%), carboplatin/pemetrexed (12%), carboplatin/gemcitabine (11%), and carboplatin/docetaxel (7%). The median overall survival from first‐line therapy initiation was 7.2 months (95% confidence interval, 7.0–7.5 months). Dyspnea and anemia were the most common AEs of interest, whereas atypical pneumonia was associated with the greatest AE‐related costs (mean,