Background: TNBC disproportionally affects younger women and is the leading cause of cancer-related deaths in women under 40. Treatment burden likely has a greater impact in younger women given employment and/or parental status. Little is known about treatment-related healthcare utilization, costs, or absenteeism or disability in women with mTNBC. This study describes real-world treatment patterns and the economic burden of mTNBC among patients treated with a first line (1L) chemotherapy. Methods: A retrospective cohort analysis of IBM MarketScan(R) Commercial and Medicare Supplemental Claims Databases was conducted. The analysis included adult female patients diagnosed with mTNBC who initiated 1L therapy from 1/1/2011 - 9/30/2017. Patients were continuously enrolled with medical and pharmacy benefits > 6 months prior to mTNBC diagnosis date and the start of 1L chemotherapy (index date) and for 3 mos after the index date. End of 1L was defined by treatment change, discontinuation (>60-day gap), or inpatient death or hospice. Patient follow-up was from the index date to the end of continuous enrollment or the end of the study period, 12/31/2017. Baseline demographic, clinical characteristics and per patient per month (PPPM) healthcare utilization and costs were analyzed descriptively. Indirect productivity burden of mTNBC using employed patient’s absenteeism (ABS), short-term disability (STD), and long-term disability (LTD) are reported. All costs are 2017 US dollars. Results: 1,027 patients with mTNBC meeting eligibility criteria were identified. Median age was 55 years; 69.5% of women were ages 45 - 64. Mean Charlson Comorbidity Index score was 8.8. Of the 27 1L treatments observed, the 3 most common were cyclophosphamide/doxorubicin (44.7%), cyclophosphamide/docetaxel (10.1%), and paclitaxel (7.7%). Median time to treatment post diagnosis was 27 days. Observed median follow-up time was 271 days; 13.2% of patients remained on 1L chemotherapy to end of follow-up. Mean duration of 1L treatment was 86 days (SD, 67 days); 69.2% of patients had a change in 1L treatment. For all-cause healthcare utilization during 1L, 11.6% patients had an inpatient admission, 16.9% had an ED visit, and 98.0% had an outpatient visit, of which 80.7%, 52.7%, and 98.8% were breast cancer-related, respectively. Mean all-cause total healthcare costs and outpatient prescription costs were $17,727 (SD $13,701) and $10,861 (SD $10,136) PPPM, respectively. Of breast cancer-related treatments, all patients received chemotherapy, 4.9% received radiation therapy, 1.2% underwent breast cancer surgery, and 96.5% received supportive care. The mean total breast cancer-related treatment cost was $10,322 (SD $9,512) PPPM. At 6 months post-index, 56 patients (5.5%) had either ABS, STD, or LTD data eligibility. Of this subset, 4 (7.1%) patients had an ABS claim and missed an average of 245 work-hours and had a mean productivity loss of $6,472. STD and LTD claims were available for 14 (25.0%) and 4 (7.1%) patients who experienced an average of 63 and 76 work-days lost and a mean loss of $9,265 and $11,192, respectively. Conclusion: Patients with mTNBC continue to experience significant treatment burden. Moreover, though many therapies were observed, limited long term treatment options are available suggesting a need for a durable treatment options that also minimize the burden for patients. Citation Format: Ashley Tabah, Ronda Copher, David Huggar, Marc Tian, Sarah S. Mougalian. Treatment patterns and costs of metastatic triple negative breast cancer (mTNBC) in US women: A retrospective cohort study of first-line chemotherapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-08-09.

Introduction: Acute myeloid leukemia (AML) poses significant economic burden on the healthcare system, particularly during induction therapy and at disease relapse. The burden associated with ongoing post-remission therapy is less clear. In patients diagnosed with AML enrolled in Medicare who received an induction therapy and achieved disease remission, we assessed the healthcare resource utilization (HCRU) and costs associated with each disease period (induction, early/late post-remission, and post-relapse). Methods: A retrospective analysis was conducted using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, comprising Medicare claims (parts A, B, and D from 2007 to 2016) and the US National Cancer Institute's SEER database (cancer diagnoses from 2007 to 2015). Identified patients had a diagnosis of AML in the SEER registry, were ≥ 65 years at the AML diagnosis date, initiated chemotherapy post-AML diagnosis (i.e. induction), and had an International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) diagnosis code for AML remission following the start of therapy. Patients were excluded if they had another blood malignancy, had received a prior hematopoietic stem cell transplant, or were enrolled in a clinical trial. Induction was defined as any therapy received from the date of first post-diagnosis chemotherapy initiation (index date) to the end of the cycle during which a patient had an ICD-9/10 code for AML remission. The 6 months prior to the index date was defined as the baseline period. Post-remission therapy was divided into an early post-remission period, which included any therapy initiated within the first 60 days (≤ 60 d) after end of induction, and a late post-remission period, which included therapy initiated more than 60 days (> 60 d) after end of induction. If specific treatment information was available, late post-remission therapy was defined by a treatment switch occurring > 60 d after end of induction. Post-remission therapy ended at the earliest of relapse or end of follow-up (i.e., death, end of eligibility, or end of available data [December 31, 2016]). The post-relapse period was from the date of first AML relapse ICD-9/10 code after remission to the end of follow-up. Baseline patient characteristics, as well as HCRU and costs (adjusted to 2019 US dollars) during the baseline, induction, post-remission, and post-relapse periods, were summarized descriptively. HCRU and costs associated with induction and post-remission therapy periods were assessed during days that were part of a treatment cycle. The average per patient per month (PPPM) HCRU and costs were reported. Duration of response (DoR) from the first remission to the earliest of relapse or death was estimated using Kaplan-Meier analysis. Results: A total of 530 patients were identified. The median age at AML diagnosis was 73 years, 53.6% of patients were male, and 80.6% were white. The median time from index date to the end of follow-up was 13.5 months. Most patients received therapy with hypomethylating agents during the AML treatment. A total of 31.9% of patients who achieved remission did not receive post-remission therapy during follow-up; for these patients, mean (median) time from end of induction to relapse or end of follow-up was 125 (23) days. A total of 63.2% of patients received chemotherapy in the early post-remission period, and 43.0% of all patients went on to receive chemotherapy in the late post-remission period. The median DoR was 5.8 months; a total of 48.9% of patients had relapsed and 80.2% had died by the end of follow-up. The mean PPPM healthcare costs were highest for induction, followed by post-relapse, early post-remission, and late post-remission periods (Table). Costs associated with the inpatient (IP) setting were the greatest contributor to PPPM costs across all periods. IP visits were most common during induction with 92.1% of patients having ≥ 1 IP visit, relative to 53.8% during baseline, 65.7% during early post-remission, 71.5% during late post-remission, and 91.1% post-relapse. Conclusions: The economic burden of relapse is approximately 1.2 and 1.6 times higher than the mean PPPM healthcare costs during early and late post-remission periods, respectively. There exists a large unmet need for therapies that will extend the duration of the post-remission period and reduce the overall economic burden of AML. Disclosures Tabah: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Huggar:Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company; Karyopharm Therapeutics: Current equity holder in publicly-traded company; FibroGen: Current equity holder in publicly-traded company. Huey:Bristol Myers Squibb: Current Employment. Copher:Bristol Myers Squibb: Current Employment. Zhou:BMS: Other: Employee of Analysis Group Inc., which received consulting fees. Zichlin:BMS: Other: Employee of Analysis Group Inc., which received consulting fees. Koenigsberg:BMS: Other: Employee of Analysis Group Inc., which received consulting fees. Brunner:Novartis: Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Research Funding; AstraZeneca: Research Funding; Forty-Seven Inc: Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees.

Aim: Evaluate the relative efficacy of oral versus injectable azacitidine (AZA) maintenance therapy in acute myeloid leukemia (AML) after complete remission. Materials & methods: Systematic literature review identified QUAZAR AML-001, HOVON 97 AML, UK NCRI AML16 and QoLESS-AZA-AMLE (sensitivity analysis) trials. Network meta-analysis and matching-adjusted indirect comparisons assessed survival outcomes. Results: In the network meta-analysis, combining the HOVON 97 and UK NCRI trials, oral AZA (QUAZAR) was associated with significantly improved overall survival (OS) versus injectable AZA (hazard ratio: 0.744; 95% credible interval: 0.557–0.998). After matching-adjusted indirect comparisons, to address differences in patient characteristics across trials, OS improvements were maintained with oral versus injectable AZA (hazard ratio: 0.753; credible interval: 0.563–0.998). Conclusion: In AML, maintenance therapy with oral AZA was associated with improved OS versus injectable AZA.

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