Abstract 95P
Background
IO has transformed the treatment of first-line (1L) metastatic NSCLC (mNSCLC) in patients without actionable biomarkers, though patients with intolerance and disease progression require subsequent treatment. With this evolution, there is a newfound need to understand the optimal sequencing and timing of regimens. This study investigated RW treatment patterns and clinical outcomes in this setting.
Methods
This retrospective observational study included adult patients with mNSCLC previously treated with 1L IO who initiated subsequent treatment between 2015-2020 in The US Oncology Network (followed through 31 March 2022). Patient characteristics and treatment patterns were assessed descriptively using structured electronic health record data. Kaplan-Meier analyses of RW overall survival (rwOS), time to treatment discontinuation (rwTTD) and time to next treatment (rwTTNT) were conducted by evaluating post-IO treatment-free interval (TFI), defined as the duration between last IO administration date and post-IO regimen start.
Results
Overall, 1,116 patients were identified (median follow-up 7.2 months). Most were age ≥65 years (62%), White (73%), male (52%) and had a history of tobacco use (82%). Subsequent treatment was initiated ≤30 days from last IO in 45% of patients, and 17% had post-IO TFI >90 days. There were no statistically significant differences in age, sex, race, tobacco use, ECOG or histology by post-IO TFI category. Post-IO regimens and clinical outcomes by post-IO TFI are summarized below. Table: 95P
| Post-IO TFI ≤30 days | Post-IO TFI 31-60 days | Post-IO TFI 61-90 days | Post-IO TFI >90 days | Logrank P-value | |
| N | 499 | 345 | 79 | 193 | - |
| Post-IO regimens, n (%) | - | ||||
| IO (resumed or switched) | 136 (27) | 66 (19) | 13 (16) | 119 (62) | |
| Docetaxel ± ramucirumab | 132 (26) | 126 (37) | 27 (34) | 22 (11) | |
| Platinum chemotherapy + pemetrexed or paclitaxel | 91 (18) | 71 (21) | 20 (25) | 16 (8) | |
| Gemcitabine | 45 (9) | 29 (8) | 7 (9) | 6 (3) | |
| Other non-IO* | 95 (19) | 53 (15) | 12 (15) | 30 (16) | |
| Outcomes, median (95% CI), months | |||||
| rwOS | 10.8 (9.2,12.2) | 7.5 (6.8,9.1) | 9.2 (5.8,17.5) | 16.0 (12.7,20.8) | <0.0001 |
| rwTTD | 3.7 (3.3,4.2) | 2.9 (2.3,3.5) | 2.8 (2.2,3.6) | 3.2 (2.4,4.0) | 0.0025 |
| rwTTNT | 6.1 (5.7,6.7) | 4.9 (4.5,5.4) | 5.7 (4.5,7.2) | 7.8 (6.1,9.7) | <0.0001 |
*Other = regimens with <5 patients in ≥1 subgroup
Conclusions
This RW study highlights the variation in treatments and outcomes by TFI among patients with mNSCLC previously treated with IO. TFI ≤30 days may represent avoided delays in treatment, whereas TFI >90 days may include patients with long-term response. Further research is needed to optimize treatment strategies in this setting.
Legal entity responsible for the study
The authors.
Funding
Mirati Therapeutics, Inc.
Disclosure
A. Spira: Financial Interests, Personal, Other, Consulting or Advisory Role: Incyte, Mirati Therapeutics, Gritstone Oncology, Jazz Pharmaceuticals, Janssen Research & Development, Mersana, Gritstone Bio, Daiichi Sankyo/AstraZeneca, Array Biopharma, Blueprint Medicines; Financial Interests, Personal, Other, Consulting or Advisory Role / Honoraria: Amgen, Novartis, Takeda, AstraZeneca/MedImmune, Merck, Bristol Myers Squibb; Financial Interests, Personal, Other, Honoraria: CytomX Therapeutics, Janssen Oncology, Bayer; Financial Interests, Institutional, Officer, CEO: NEXT Oncology Virginia; Financial Interests, Personal, Stocks/Shares: Eli Lilly; Financial Interests, Institutional, Invited Speaker: LAM Therapeutics, Roche, AstraZeneca, Boehringer Ingelheim, Astellas Pharma, MedImmune, Novartis, Newlink Genetics, Incyte, AbbVie, Ignyta, Trovagene, Takeda, Macrogenics, CytomX Therapeutics, Astex Pharmaceuticals, Bristol Myers Squibb, Loxo, Arch Therapeutics, Gritstone, Plexxikon, Amgen, Daiichi Sankyo, ADCT, Janssen Oncology, Mirati Therapeutics, Rubius, Synthekine, Mersana, Blueprint Medicines, Kezar, Revolution Med. B. Korytowsky: Financial Interests, Institutional, Full or part-time Employment: Mirati Therapeutics; Financial Interests, Institutional, Stocks/Shares: Mirati Therapeutics, Bristol Myers Squibb, Pfizer. S. Gao: Financial Interests, Institutional, Full or part-time Employment, RWE Biostatistician: Mirati Therapeutics, Inc.; Financial Interests, Institutional, Stocks/Shares: Mirati Therapeutics, Inc.; Non-Financial Interests, Personal, Other, RWE Biostatistician: Mirati Therapeutics, Inc.; Non-Financial Interests, Institutional, Proprietary Information: Mirati Therapeutics, Inc. T. Wilson: Financial Interests, Institutional, Full or part-time Employment, Senior Scientific Director: McKesson/Ontada; Financial Interests, Personal, Stocks/Shares, Own shares: McKesson Inc.; Non-Financial Interests, Personal, Member of Board of Directors, Chairman of the Board of a non-profit (uncompensated): Population Health Impact Institute (501c3). A. Osterland: Financial Interests, Institutional, Full or part-time Employment: McKesson/Ontada. P. Conkling: Financial Interests, Personal, Full or part-time Employment: Ontada; Financial Interests, Personal, Invited Speaker, Received pay for my work as Physician Investigator for a retrospective study of esophago-gastric carcinoma in US community oncology practices.: Daiichi Sankyo. All other authors have declared no conflicts of interest.