TY - JOUR
T1 - Durvalumab Treatment Patterns for Patients with Unresectable Stage III Non-Small Cell Lung Cancer in the Veterans Health Administration (VHA)
T2 - A Nationwide, Real-World Study
AU - Moore, Amanda M.
AU - Nooruddin, Zohra
AU - Reveles, Kelly R.
AU - Datta, Paromita
AU - Whitehead, Jennifer M.
AU - Franklin, Kathleen
AU - Alkadimi, Munaf
AU - Williams, Madison H.
AU - Williams, Ryan A.
AU - Smith, Sarah
AU - Reichelderfer, Renee
AU - Cotarla, Ion
AU - Brannman, Lance
AU - Frankart, Andrew
AU - Mulrooney, Tiernan
AU - Hsieh, Kristin
AU - Simmons, Daniel J.
AU - Jones, Xavier
AU - Frei, Christopher R.
N1 - Publisher Copyright:
© 2023 by the authors.
PY - 2023/9
Y1 - 2023/9
N2 - Background: Durvalumab is approved for the treatment of adults with unresectable stage III non-small cell lung cancer (NSCLC) post-chemoradiotherapy (CRT). This real-world study describes patient characteristics and durvalumab treatment patterns (number of doses and therapy duration; treatment initiation delays, interruptions, discontinuations, and associated reasons) among VHA-treated patients. Methods: This was a retrospective cohort study of adults with unresectable stage III NSCLC receiving durvalumab at the VHA between 1 January 2017 and 30 June 2020. Patient characteristics and treatment patterns were presented descriptively. Results: A total of 935 patients were included (median age: 69 years; 95% males; 21% Blacks; 46% current smokers; 16% ECOG performance scores ≥ 2; 50% squamous histology). Durvalumab initiation was delayed in 39% of patients (n = 367). Among the 200 patients with recorded reasons, delays were mainly due to physician preference (20%) and CRT toxicity (11%). Overall, patients received a median (interquartile range) of 16 (7–24) doses of durvalumab over 9.0 (2.9–11.8) months. Treatment interruptions were experienced by 19% of patients (n = 180), with toxicity (7.8%) and social reasons (2.6%) being the most cited reasons. Early discontinuation occurred in 59% of patients (n = 551), largely due to disease progression (24.2%) and toxicity (18.2%). Conclusions: These real-world analyses corroborate PACIFIC study results in terms of the main reasons for treatment discontinuation in a VHA population with worse prognostic factors, including older age, predominantly male sex, and poorer performance score. One of the main reasons for durvalumab initiation delays, treatment interruptions, or discontinuations was due to toxicities. Patients could benefit from improved strategies to prevent, identify, and manage CRT and durvalumab toxicities timely and effectively.
AB - Background: Durvalumab is approved for the treatment of adults with unresectable stage III non-small cell lung cancer (NSCLC) post-chemoradiotherapy (CRT). This real-world study describes patient characteristics and durvalumab treatment patterns (number of doses and therapy duration; treatment initiation delays, interruptions, discontinuations, and associated reasons) among VHA-treated patients. Methods: This was a retrospective cohort study of adults with unresectable stage III NSCLC receiving durvalumab at the VHA between 1 January 2017 and 30 June 2020. Patient characteristics and treatment patterns were presented descriptively. Results: A total of 935 patients were included (median age: 69 years; 95% males; 21% Blacks; 46% current smokers; 16% ECOG performance scores ≥ 2; 50% squamous histology). Durvalumab initiation was delayed in 39% of patients (n = 367). Among the 200 patients with recorded reasons, delays were mainly due to physician preference (20%) and CRT toxicity (11%). Overall, patients received a median (interquartile range) of 16 (7–24) doses of durvalumab over 9.0 (2.9–11.8) months. Treatment interruptions were experienced by 19% of patients (n = 180), with toxicity (7.8%) and social reasons (2.6%) being the most cited reasons. Early discontinuation occurred in 59% of patients (n = 551), largely due to disease progression (24.2%) and toxicity (18.2%). Conclusions: These real-world analyses corroborate PACIFIC study results in terms of the main reasons for treatment discontinuation in a VHA population with worse prognostic factors, including older age, predominantly male sex, and poorer performance score. One of the main reasons for durvalumab initiation delays, treatment interruptions, or discontinuations was due to toxicities. Patients could benefit from improved strategies to prevent, identify, and manage CRT and durvalumab toxicities timely and effectively.
KW - chemoradiotherapy
KW - chemotherapy
KW - durvalumab
KW - immunotherapy
KW - lung cancer
KW - pharmacoepidemiology
KW - radiotherapy
KW - stage III NSCLC
UR - http://www.scopus.com/inward/record.url?scp=85172165599&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85172165599&partnerID=8YFLogxK
U2 - 10.3390/curroncol30090611
DO - 10.3390/curroncol30090611
M3 - Article
C2 - 37754526
AN - SCOPUS:85172165599
SN - 1198-0052
VL - 30
SP - 8411
EP - 8423
JO - Current Oncology
JF - Current Oncology
IS - 9
ER -