College of Pharmacy, The University of Texas at Austin, Austin, TX
Amanda Moore , Zohra Nooruddin , Kelly R Reveles , Paromita Datta , Lance Brannman , Ion Cotarla , Andrew Frankart , Tiernan Mulrooney , Xavier Jones , Christopher R Frei
Background: Evidence from the PACIFIC study and real-world data highlight the benefit of durvalumab in patients with stage III unresectable non-small cell lung cancer (UR-NSCLC). However, limited literature exists regarding disparities in durvalumab treatment patterns such as treatment initiation delays (TID), treatment interruptions (TI), number of doses, duration of therapy (DOT), adverse effects (AEs), and treatment discontinuation (TD) in minority populations. Methods: Patients with stage III UR-NSCLC and a self-reported racial identity of Black or White treated with durvalumab following chemoradiotherapy (CRT) at any Veterans Health Administration (VHA) facility from January 1, 2017 to June 30, 2020 were included. Patients were followed from their date of durvalumab initiation through the earliest of their last VHA visit, loss to follow up, death, or end of the study; therefore, all patients had the opportunity to be treated for 12 months. Patients were excluded if durvalumab therapy was ongoing at the end of the study. Patient charts were retrospectively reviewed for baseline characteristics and durvalumab treatment patterns including TID (>42 days from end of CRT to durvalumab start), TI (>28 days between doses), number of doses, DOT, AEs, and TD. Nominal variables were compared using chi-square/Fisher’s exact tests. Continuous variables were compared using Student’s t-tests/Wilcoxon Rank Sum tests. Results: Among 924 patients, Black patients were younger than White patients (median age 67 years [IQR, 63-71] vs. 70 years [IQR, 65-73]; p<0.01), more likely to be current smokers (54% vs. 45%; p=0.03), with more chronic liver disease (22% vs. 9%; p<0.01), but less COPD (63% vs. 72%; p=0.01). Black patients experienced more TI (25% vs. 18%; p=0.03) but TID, number of doses, DOT, and TD were similar between the groups. Black patients were less likely to have an immune-related AE (irAE) (28% vs. 36%; p=0.03) (and less pneumonitis (7% vs. 14%; p<0.01)). Toxicity was the reason for TD in 12% of Black patients vs. 20% of White patients (p=0.01), with no other significant (α< 0.05) differences in reported reasons for TID, TI, or TD between the groups. Conclusions: In this real-world study, Black patients experienced similar TID, number of doses, and DOT as White patients. Black patients were less likely to experience an irAE (including pneumonitis) but experienced more TI; TD were similar but more likely to be from toxicity for White patients. Future research is needed to validate these findings.
Outcome | White (n=726) | Black (n=198) | P-value |
---|---|---|---|
Patients with TID | 38% | 45% | 0.07 |
Patients with TI | 18% | 25% | 0.03 |
Number of doses, median (IQR) | 15 (7-24) | 18 (7-25) | 0.25 |
DOT (months), median (IQR) | 8.7 (2.9-11.8) | 9.8 (3.6-12.0) | 0.08 |
Patients with irAEs | 36% | 28% | 0.03 |
Pneumonitis | 14% | 7% | <0.01 |
Patients with TD | 60% | 54% | 0.09 |
Disclaimer
This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org
Abstract Disclosures
2024 ASCO Annual Meeting
First Author: Dae-Ho Choi
2023 ASCO Annual Meeting
First Author: Elizabeth M. Burton
2023 ASCO Annual Meeting
First Author: Feifei Teng
2022 ASCO Annual Meeting
First Author: Paromita Datta