Treatment Patterns in Patients with Locally Advanced or Metastatic Non-Small-Cell Lung Cancer Treated with Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors: Analysis of US Insurance Claims Databases

Ross A Soo; Takashi Seto; Jhanelle E Gray; Ellen Thiel; Aliki Taylor; William Sawyer; Parisa Karimi; Elizabeth Marchlewicz; Matthew Brouillette

doi:10.1007/s40801-021-00272-5

Treatment Patterns in Patients with Locally Advanced or Metastatic Non-Small-Cell Lung Cancer Treated with Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors: Analysis of US Insurance Claims Databases

Drugs Real World Outcomes. 2022 Mar;9(1):31-41. doi: 10.1007/s40801-021-00272-5. Epub 2021 Sep 12.

Authors

Ross A Soo¹, Takashi Seto², Jhanelle E Gray³, Ellen Thiel⁴, Aliki Taylor⁵, William Sawyer⁶, Parisa Karimi⁷, Elizabeth Marchlewicz⁴, Matthew Brouillette⁴

Affiliations

¹ Department of Haematology-Oncology, National University Cancer Institute, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore. [email protected].
² Department of Thoracic Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
³ Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
⁴ Custom Data Analytics, IBM Watson Health, Cambridge, MA, USA.
⁵ Oncology Business Unit, AstraZeneca, Cambridge, UK.
⁶ Biometrics Oncology, AstraZeneca, Cambridge, UK.
⁷ Oncology Business Unit, AstraZeneca, Gaithersburg, MD, USA.

Abstract

Background: Most patients with epidermal growth factor receptor mutation-positive (EGFRm) non-small-cell lung cancer (NSCLC) acquire resistance to first-line (1L) first- or second-generation (1G/2G) EGFR-TKIs; therefore, it is important to optimize 1L treatment to improve patient outcomes.

Objective: To retrospectively examine treatment patterns in locally advanced/metastatic NSCLC using MarketScan^® Commercial and Medicare Supplemental Databases (all US census regions).

Patients and methods: Adults with a lung cancer diagnosis code between 1 January 2015-31 March 2018 were analyzed from diagnosis (index) through a variable-length follow-up. Patients had ≥ 1 pharmacy claim for 1G/2G EGFR-TKIs on or within 60 days post-index. Data were stratified by presence or absence of central nervous system (CNS) metastases (30 days pre-index through study end).

Results: 578 patients were included (median age 63 years, 64% female). Median follow-up was 13.5 months. The most frequently prescribed 1L EGFR-TKI was erlotinib (414/578, 72%). Median time to 1L treatment discontinuation was 8.2 (95% confidence interval (CI) 6.9, 9.0) months in patients diagnosed with CNS metastases at any time, and 7.7 (95% CI 6.9, 8.9) months in patients without CNS metastases. 270/578 patients (47%) discontinued 1L EGFR-TKIs; 209/270 (77%) initiated second-line (2L) therapy, most frequently osimertinib (96/209, 46%).

Conclusions: In an analysis of US claims data, nearly half of patients discontinued 1L EGFR-TKIs, and 46% who initiated 2L received osimertinib. As nearly a quarter of patients who discontinued 1L EGFR-TKIs did not receive 2L treatment, this study highlights the need for optimal 1L treatment in EGFRm locally advanced/metastatic NSCLC.