458P - A real-world depiction of difficulties in applicability of IO regimens into clinical practice in metastatic setting

Background

Overall survival across various cancers in metastatic setting has been on the rise with the advent of immunotherapy. Indications include chemoimmunotherapy, immunotargeted therapy and immunotherapy alone basing on the approvals across various lines in particular organ type. However, applicability of the same into real world practice has been dismal in low and middle income countries due to various reasons. Data is lacking in this setting.

Methods

We conducted an observational study at our center to see applicability of IO indications across different metastatic cancers. Consecutive patients between Jan 2018 and Feb 2022 who had metastatic cancer and an indication for IO usage were enrolled and their treatment regimens studied. Patients across different primary sites were included with approved IO regimen. Reasons for non-usage of IO were studied.

Results

Between Jan 2018 and Feb 2022, 464 patients were enrolled who were eligible for treatment with IO either as a single agent or as combination in metastatic setting. The most common indication was NSCLC (21.9%), head & neck (21.1%),RCC (7.7%), bladder (9.4%), endometrium (9.4%), gastric (9%)HCC (8.1%), Hodgkins lymphoma (3.8%),melanoma (3%),SCLC(3%) and so on. Of 464 patients, only 138(29.7%) were finally treated with IO regimen across different lines. The reasons for non-usage were financial constraints (76.3%) which included exhaustion of insurance limit followed by denial by insurance company (18%), non-availability of drug (3.4%) and contraindication to IO(2.3%). Of the 138 patients who were treated, 32.4 % had to withdraw the drug owing to financial toxicity while the disease was still responding with the median time to withdrawal being 5.8 months.

Conclusions

This observational study portrays a real world picture of difficulties faced in using approved IO regimens in metastatic setting with financial constraints leading to non-usage/withdrawal of drug in nearly 62 % patients.There is an urgent need to address this financial toxicity to benefit more patients with IO agents in lower middle income countries like India.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The author.

Funding

Has not received any funding.

Disclosure

The author has declared no conflicts of interest.