Abstract 1149P
Background
ICIs are recommended for 1L use for aNSCLC with high PD-L1 expression by international guidelines, but disparities in use and outcomes remain. This study explored how factors associated with not receiving 1L ICI differed among pts <65 and ≥65 years (y).
Methods
Using the nationwide de-identified electronic health record-derived Flatiron Health aNSCLC database, a retrospective cohort study was conducted for pts with aNSCLC diagnosed during 1/1/18-7/31/21 with a PD-L1 level ≥50% before or within 28 days of the date of 1L initiation (index date), excluding pts with known ALK/EGFR/ROS1 mutations. Logistic regression models were used to examine baseline demographic (age, sex, race, region, insurance, practice setting, year of diagnosis) and clinical (PD-L1 levels, recurrent or de novo aNSCLC, liver/brain/bone metastases, ECOG performance status, histology) factors associated with no ICI use in 1L among pts aged ≥65 and <65y.
Results
A total of 3,370 aNSCLC pts were included: 70% ≥65y; 52% male; and ∼20% not receiving 1L ICI. In pts aged ≥65y at aNSCLC diagnosis, having a lower PD-L1 level, commercially insured (vs. Medicare), ECOG PS scores of 0-1 (vs. 2-4), squamous (vs. non-squamous) histology, or no brain/bone/liver metastases (vs having such metastasis) was significantly associated with a higher likelihood of not receiving 1L ICI. While in pts <65y, only squamous histology and no brain/bone metastases were significantly associated with no ICI use in 1L. Table: 1149P
Selected factors* associated with no ICI use in 1L
| Variable | Odds Ratios (95%CI) | |
| Age ≥65y (N=2352) | Age <65y (N=1018) | |
| PD-L1 level, % (Ref: 90-100) | ||
| 50-59 | 1.6 (1.2-2.3) | 1.0 (0.6-1.6) |
| 60-89 | 1.2 (0.9-1.5) | 0.8 (0.6-1.1) |
| Payer (Ref: Medicare) | ||
| Commercial | 1.4 (1.1-1.8) | 0.8 (0.4-1.6) |
| Medicaid | 0.9 (0.2-4.1) | 0.4 (0.1-1.4) |
| Other | 1.3 (0.9-1.8) | 1.0 (0.5-2.0) |
| Histology (Ref: non-squamous) | ||
| NOS | 1.3 (0.8-2.0) | 1.4 (0.7-2.7) |
| Squamous | 1.4 (1.1-1.8) | 1.7 (1.2-2.5) |
| ECOG PS (Ref: 2-4) | ||
| 0-1 | 1.9 (1.4-2.6) | 1.4 (0.9-2.3) |
| Missing | 1.7 (1.2-2.5) | 1.1 (0.6-1.9) |
| Metastasis (Ref: no such metastasis) | ||
| Liver | 0.5 (0.3-1.0) | 0.6 (0.3-1.6) |
| Brain | 0.5 (0.3-0.8) | 0.5 (0.3-0.8) |
| Bone | 0.3 (0.2-0.5) | 0.4 (0.2-0.6) |
*See Methods for full model.
Conclusions
About 20% patients with aNSCLC and high PD-L1 expression did not receive ICI in 1L. In both age groups, non-ICI use was generally driven by clinical rather than sociodemographic characteristics. Future research is needed to address the differences in underlying factors identified and to improve 1L ICI use in aNSCLC.
Clinical trial identification
Editorial acknowledgement
Medical writing support was provided by John G Facciponte, PhD, of Prime, Knutsford, UK, funded by Regeneron Pharmaceuticals, Inc, and Sanofi.
Legal entity responsible for the study
Regeneron Pharmaceuticals, Inc., and Sanofi.
Funding
Regeneron Pharmaceuticals, Inc., and Sanofi.
Disclosure
J. Feliciano: Financial Interests, Personal, Research Grant: AstraZeneca, Bristol-Myers Squibb, Pfizer; Financial Interests, Personal, Advisory Role: AstraZeneca, Coherus, Eli Lilly, Genentech, Merck, Regeneron Pharmaceuticals Inc., Takeda. N. Wu, W. Ge, R. Quek, J.J. Jalbert, J. Harnett: Financial Interests, Personal, Full or part-time Employment: Regeneron Pharmaceuticals, Inc.; Financial Interests, Personal, Stocks/Shares: Regeneron Pharmaceuticals, Inc. M. Gleeson: Financial Interests, Personal, Full or part-time Employment: Genesis Research, LLC. All other authors have declared no conflicts of interest.