(113) Real World Prevalence and Use of Immune Checkpoint Inhibitors Among Non-Small Cell Lung Cancer Patients in a Comprehensive Cancer Center

Publication Number: 787

Background: Lung cancer (LC) is the third most common cancer in the US and optimal treatments depends on its subtype such as non-small cell lung cancer (NSCLC) vs. small cell lung cancer. However, claims data using ICD coding system do not differentiate its subtypes. With limited therapeutic benefits from standard cytotoxic treatment in case of NSCLC (80-90% of LC), targeted treatments have been developed including immune checkpoint inhibitors (ICIs), which were shown to improve outcomes in NSCLC but also were associated with unique side effects. While ICIs might have shifted the treatment paradigm away from cytotoxic therapy alone, data on real-world prevalence of NSCLC and trend in ICI use as first-line therapy are limited.

Objectives: To assess the prevalence of NSCLC, and trend and predictors of ICI use among NSCLC patients.

Methods: Using EHR data from a National Cancer Institute-designated comprehensive cancer center, we identified LC patients diagnosed between 1/2011-6/2021 and underwent genomic sequence testing. We identified NSCLC patients and categorized use of ICIs including pembrolizumab, ipilimumab, nivolumab, atezolizumab and durvalumab into 1) first-line (given ICI alone or in combination), and 2) second/later-line therapy. We identified demographics and comorbidities. We described prevalence of NSCLC and trend of ICI use as first-line therapy over each year. We used logistic regression to predict first-line ICI use with predictors age, gender, race, ethnicity, and comorbidities in NSCLC patients.

Results: Among 2231 lung cancer patients, 82% (1829) were NSCLC. Among 1829 NSCLC patients (mean age 67, 47% male, 67% non-Hispanic White), 12% (216) patients received ICI alone or in combination with chemotherapy with pembrolizumab as the most common agent (84%). The use of ICI in NSCLC has increased from 3% (2011) to 15% (2015), 24% (2018) and as high as 33% (2020). Among 216 ICI users (mean age 66, 44% male, 73% non-Hispanic White, 42% hypertension, 16% diabetes, 9% hypothyroidism and 3% autoimmune comorbidity), 38% received ICI as the first line therapy. In multivariate logistic regression for ICI users, hypertension (OR 0.5, 95%CI 0.3-0.7) and older age >66 (OR 0.53, 95%CI 0.36-0.78) predicted lower first-line ICI use.

Conclusions: ICI use has increased dramatically after 2015. The observed increase in the ICI use followed FDA’s approval of ICIs in 2015 for metastatic NSCLC with programmed death-ligand 1 (PD-L1) expression. However, its use as the first-line is still limited to < 40 % of NSCLC patients. Hypertension and older age predicted lower ICI use as the first-line therapy. Further research is underway to assess the impact of LC stage and genetic markers.