https://orcid.org/0000-0003-0976-9177
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Abstract
Aim: We assessed treatment patterns and outcomes in patients with metastatic nonsquamous non-small-cell lung cancer (mNSCLC) who initiated first-line pembrolizumab–platinum–pemetrexed (induction) in US community oncology settings. Methods: Patients initiating induction were retrospectively identified. Patients continuing pembrolizumab afterward underwent chart review. Clinical outcomes were described by maintenance pemetrexed exposure after inverse probability of treatment weighting (IPTW). Results: Median induction pembrolizumab and pemetrexed durations were 5.1 and 4.2 months. Among patients continuing pembrolizumab after induction, 64% received maintenance pemetrexed. Common discontinuation reasons for induction pemetrexed were completion of planned therapy (79%) and partial response (68%) and progressive disease (38%) and toxicity (29%) for maintenance pemetrexed. After IPTW, median overall survival and real-world progression-free survival were longer in patients continuing pembrolizumab with versus without maintenance pemetrexed (20.3 vs 12.0 months and 10.3 vs 5.8 months, respectively). Conclusion: Patient characteristics and planned treatment decisions affect maintenance pemetrexed utilization in the community oncology setting.
Plain language summary
What is this summary about?
Pembrolizumab is a drug that helps the lung cancer patient’s immune system fight the cancer, even after the cancer has spread, or metastasized. After the patient gets better, the patient is treated with chemotherapy so the cancer will not come back. This is called ‘maintenance treatment’. In KEYNOTE-189, a clinical trial, patients lived longer if they had pembrolizumab added to pemetrexed and platinum, which are chemotherapy drugs. If patients had maintenance treatment with pembrolizumab and pemetrexed, they also lived longer. However, do patients in community practices get those treatments?
What were the results?
We found that at cancer practices in the community instead of clinical trials, not all patients received pemetrexed in maintenance treatment. Many had finished their planned therapy and their tumors had shrunk. Also, some physicians chose not to give their patients pemetrexed. In addition, some women and some older and sicker patients did not get pemetrexed. Some patients had pemetrexed in maintenance but stopped because their cancer grew worse or because they had side effects. Those patients did not live as long as patients who did have maintenance pemetrexed.
What do the results mean?
Patients with metastatic non-small-cell lung cancer in the community practice do better on the treatments tested in clinical trials. However, certain patients do not get those treatments. The reasons need to be understood, to make sure that those patients get better treatments.
Supplementary data
To view the supplementary data that accompany this paper please visit the journal website at: www.tandfonline.com/doi/suppl/10.2217/imt-2023-0313
Acknowledgments
We acknowledge L Kaspin-Powell for medical writing and editing support.
Financial disclosure
Ontada received funding from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc, Rahway, NJ, USA for conducting this study. JH Goldschmidt: employee of The US Oncology Network, consulting or advisory role (Amgen), speakers bureau (G1 Therapeutics). S Annavarapu: employee of Ontada. D Venkatasetty, MPH: employee of Ontada. Y Wang: employee of Ontada. ML Santorelli: employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, New Jersey, and stockholder of Merck & Co., Inc., Rahway, NJ, USA. T Burke: employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, New Jersey, and stockholder of Merck & Co., Inc., Rahway, NJ, USA. NA Pennell: consulting or advisory roles with Lilly, Merck, Genentech, Pfizer, Janssen Oncology, Sanofi/Regeneron, ResistanceBio, Takeda, Novartis, Anheart, Iovance, and Bayer; and research funding (to their institution) from Genentech, AstraZeneca, Merck, Loxo, Altor BioScience, Spectrum Pharmaceuticals, BMS, Jounce Therapeutics, Mirati Therapeutics, Heat Biologics, Altor, WindMIL, Anheart, Navire, Summit, and Sanofi. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Competing interests disclosure
The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Writing disclosure
No writing assistance was utilized in the production of this manuscript.
Ethical conduct of research disclosure
The study received an exemption and waiver of informed consent and authorization from the US Oncology Institutional Review Board. This study involved analysis of existing data and records and the information was analyzed in such a manner that research participants were not directly identified.