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

Bittoni, Marisa; Arunachalam, Ashwini; Li, Haojie; Camacho, Ramon; Jian, He; Zhong, Yichen; Lubiniecki, Gregory M.; Carbone, David P.

doi:10.1016/j.cllc.2018.04.017

Cited by 46 publications

(52 citation statements)

References 32 publications

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“…Shah et al found that the PFS of patients treated with platinum + Pem was longer than those treated with Car + Pac (134 vs. 106 days; P < 0.001) . Bittoni et al found that Car + Pem treatment was related to a higher survival probability from 18 to 63 months than Car + Pac . In our study, however, the mPFS of patients with Bev alone maintenance therapy was 8.7 months in both groups; only 41 patients were treated with Bev maintenance in the PemPBev group and 33 experienced disease progression.…”

Section: Discussioncontrasting

confidence: 66%

“…25 Bittoni et al found that Car + Pem treatment was related to a higher survival probability from 18 to 63 months than Car + Pac. 26 In our study, however, the mPFS of patients with Bev alone maintenance therapy was 8.7 months in both groups; only 41 patients were treated with Bev maintenance in the PemPBev group and 33 experienced disease progression. Therefore it remains unknown whether Pem or Pac is the better treatment choice; Pem induction therapy was no worse than Pac.…”

Section: Discussioncontrasting

confidence: 61%

“…However, no head‐to‐head Pem and Pax‐based prospective study has been conducted until now . A few small retrospective studies have shown that platinum + Pem seems to achieve longer PFS and OS than platinum + Pac . Shah et al found that the PFS of patients treated with platinum + Pem was longer than those treated with Car + Pac (134 vs. 106 days; P < 0.001) .…”

Section: Discussionmentioning

confidence: 99%

“…23,24 A few small retrospective studies have shown that platinum + Pem seems to achieve longer PFS and OS than platinum + Pac. 25,26 Shah et al found that the PFS of patients treated with platinum + Pem was longer than those treated with Car + Pac (134 vs. 106 days; P < 0.001). 25 Bittoni et al found that Car + Pem treatment was related to a higher survival probability from 18 to 63 months than Car + Pac.…”

Section: Discussionmentioning

confidence: 99%

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First‐line pemetrexed/carboplatin or cisplatin/bevacizumab compared with paclitaxel/carboplatin/bevacizumab in patients with advanced non‐squamous non‐small cell lung cancer with wild‐type driver genes: A real‐world study in China

Chang

Zhang

et al. 2019

Thoracic Cancer

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Background The study was conducted to compare the effectiveness and safety of pemetrexed/carboplatin or cisplatin/bevacizumab (PemPBev) and paclitaxel/carboplatin/bevacizumab (PacCBev) as first‐line therapy for advanced non‐squamous non‐small cell lung cancer (NS‐NSCLC) patients with wild‐type driver genes in a real‐world setting. Methods We retrospectively collected the medical records of advanced NS‐NSCLC patients with wild‐type driver genes administered first‐line PemPBev or PacCBev therapy at Shanghai Chest Hospital between January 2014 and June 2016, and analyzed the differences in survival outcomes, efficacy, and safety between PemPBev and PacCBev treatment. Results A total of 390 patients were included in our analysis: 249 in the PemPBev group and 141 in the PacCBev group. Patients administered PemPBev experienced significantly improved progression‐free survival (PFS) and overall survival (OS) compared to those administered PacCBev (PFS 7.5 vs. 6.2 months, hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.53–0.84, P < 0.001; OS:18.6 vs. 16.0 months, HR 0.68, 95% CI 0.52–0.90, P = 0.002). The objective response rate (ORR) and disease control rate (DCR) were similar between the groups (ORR 21.7% vs. 30.5%, P = 0.053; DCR 69.1% vs. 67.4%, P = 0.728). There was no significant difference in the incidence of adverse events between the groups (64.7% vs. 68.8%; P = 0.407), but the incidence of peripheral neuropathy in the PacCBev group was higher than in the PemPBev group (7.8% vs. 2.4%; P = 0.012). Conclusion Our study shows that for advanced NS‐NSCLC patients with wild‐type driver genes, first‐line PemPBev might be a better treatment option compared to PacCBev.

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Section: Discussioncontrasting

confidence: 66%

Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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First‐line pemetrexed/carboplatin or cisplatin/bevacizumab compared with paclitaxel/carboplatin/bevacizumab in patients with advanced non‐squamous non‐small cell lung cancer with wild‐type driver genes: A real‐world study in China

Chang

Zhang

et al. 2019

Thoracic Cancer

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“…Patients can receive standard chemotherapy with platinum or nonplatinum agents, bevacizumab (a VEGF inhibitor) combinations, targeted therapy with tyrosine kinase inhibitors (TKI), or immunotherapy, depending on histology and biomarker results (National Comprehensive Cancer Network Guidelines, www.nccn.org). Although all types of systemic therapy extend survival, a large proportion of patients with NSCLC remain untreated (4-7) and use of targeted treatments and bevacizumab combinations have remained fairly low (3,(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

Maguire

Morris

Parikh‐Patel

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Management of advanced-stage non-small cell lung cancer (NSCLC) has changed significantly over the past two decades with the development of numerous systemic treatments, including targeted therapies. However, a high proportion of advanced-stage patients are untreated. The role that health insurance plays in receipt of systemic treatments is unclear.Methods: Using California Cancer Registry data (2012-2014), we developed multivariable Poisson regression models to assess the independent effect of health insurance type on systemic treatment utilization among patients with stage IV NSCLC. Systemic treatment information was manually abstracted from treatment text fields.Results: A total of 17,310 patients were evaluated. Patients with Medicaid/other public insurance were significantly less likely to receive any systemic treatments [risk ratio (RR), 0.78; 95% confidence interval (CI), 0.75-0.82], bevacizumab combinations (RR, 0.57; 95% CI, 0.45-0.71), or tyrosine kinase inhibitors (RR, 0.70; 95% CI, 0.60-0.82) compared with the privately insured. Patients with Medicare or dual Medicare-Medicaid insurance were not significantly different from the privately insured in their likelihood of receiving systemic treatments.Conclusions: Substantial disparities in the use of systemic treatments for stage IV NSCLC exist by source of health insurance in California. Patients with Medicaid/other public insurance were significantly less likely to receive systemic treatments compared with their privately insured counterparts.Impact: Source of health insurance influences care received. Further research is warranted to better understand barriers to treatment that patients with Medicaid face.

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Effect of targeted therapy and immunotherapy on advanced nonsmall‐cell lung cancer outcomes in the real world

Shokoohi¹,

Al-Hashami

Moore

et al. 2021

Cancer Medicine

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The evolution of diagnosis and treatment of advanced nonsmall‐cell lung cancer (NSCLC) has led to increasing the use of targeted therapy and immune checkpoint inhibitors. The study goal was to assess the effect of molecular testing and the introduction of new therapies on overall survival (OS). All patients with stage IV NSCLC referred to BC Cancer were included in the study. Four 1‐year time cohorts were created based on molecular testing implementation and funded drug availability: C1 baseline (2009), C2 EGFR TKI access (2011), C3 ALK inhibitor access (2015), C4 immunotherapy availability (2017). Baseline demographics, disease characteristics, and systemic therapy details were collected retrospectively. OS was calculated using the Kaplan–Meier method and compared using the log‐rank test. There were 3421 patients identified with stage IV NSCLC and 1319 (39%) received systemic therapy. In the four 1‐year time cohorts C1/C2/C3/C4: driver mutation‐targeted treatment increased 1/17/27/34% (of total systemic therapy), as did treatment with any line immunotherapy <1/1/9/38%. Median OS with best supportive care (BSC) was 3.4/3.1/3.2/2.9 m (p = 0.16) and with systemic treatment 9.9/10.9/13.9/15.0 m (p < 0.001). Median OS by treatment exposure was BSC 3.1 m, chemotherapy only 7.3 m, targeted therapy 17.5 m, and immunotherapy 20.7 m. In our real‐world study, following the introduction of targeted therapy and immune checkpoint inhibitors, there was a significant improvement in OS in each successive time cohort concordant with advancements in therapeutic options.

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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

Abstract: These real-world data illustrate the most common first-line regimens by histology, overall survival, AEs, and some of the high AE-related costs of therapy for advanced NSCLC, and provides extremely useful information for clinicians.

Cited by 46 publications

References 32 publications

First‐line pemetrexed/carboplatin or cisplatin/bevacizumab compared with paclitaxel/carboplatin/bevacizumab in patients with advanced non‐squamous non‐small cell lung cancer with wild‐type driver genes: A real‐world study in China

First‐line pemetrexed/carboplatin or cisplatin/bevacizumab compared with paclitaxel/carboplatin/bevacizumab in patients with advanced non‐squamous non‐small cell lung cancer with wild‐type driver genes: A real‐world study in China

Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

Effect of targeted therapy and immunotherapy on advanced nonsmall‐cell lung cancer outcomes in the real world

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