Carboplatin beyond 4 cycles during therapy with carboplatin, pemetrexed, and pembrolizumab for advanced non-small cell lung cancer (NSCLC).

Authors

null

Yaser Ahmad

Morsani College of Medicine, University of South Florida, Tampa, FL

Yaser Ahmad , Dung-Tsa Chen , Jhanelle Elaine Gray , Tawee Tanvetyanon

Organizations

Morsani College of Medicine, University of South Florida, Tampa, FL, Moffitt Cancer Center, Tampa, FL

Research Funding

No funding received
None.

Background: Since the publication of KEYNOTE-189 study, carboplatin/pemetrexed/pembrolizumab (carbo/pem/pembro) has become a common frontline regimen for advanced non-small cell lung cancer (NSCLC). In KEYNOTE-189, carboplatin was administered for a maximum of 4 cycles. To date, the number of carboplatin cycles administered in the real-world setting remains unclear. We analyzed factors predicting the receipt of carboplatin beyond 4 cycles (CB4). Methods: We interrogated a population-based, real-world database by Flatiron for NSCLC patients with no actionable EGFR/ALK who received carbo/pem/pembro from March to July 2019 (pre-pandemic period) and from March to July 2020 (pandemic period). Patients were included if they completed the regimen as shown by transitioning to maintenance pem, pembro, or pem/pembro. Primary endpoint was CB4. Secondary endpoint was overall survival. Multivariable logistic regression analyses were performed to identify independent predictors of receiving CB4. Results: Among 2090 patients treated during the study period, 966 patients (46%) started on carbo/pem/pembro and subsequently proceeded to maintenance therapy. Among them, 134 patients (14%) received CB4. Multivariable analysis revealed the following statistically significant predictors of receiving CB4, along with respective odds ratios (95% CI) and p-values: Non-white race 1.67 (1.09-2.57) (p=0.017), ECOG ≥1 1.66 (1.07-2.59) (p= 0.024), pandemic year 2020 1.68 (1.11- 2.52) (p=0.013), and ever-smoking status 0.51 (0.30-0.87) (p=0.013). Survival analysis is ongoing. Conclusions: A significant number of patients received CB4. Since this practice is not considered a standard practice, the benefits and risks of CB4 is unknown. Predictors of receiving CB4 included year of treatment, race, ECOG, and smoking status. Further investigation is needed to understand patient-physician decision making process with regards to the length of carboplatin administration.

Univariable analysis.

CharacteristicsReceived CB4
n/N (%)
P-value
Sex:
Male
Female

68/523 (13.0)
66/443 (14.9)
0.39
Age:
<65 years
≥65 years

51/318 (16.0)
83/648 (12.8)
0.17
Race:
White
Non-white

77/641 (12.0)
40/216 (18.5)
0.02
ECOG:
0
≥1

95/743 (12.8)
39/223 (17.5)
0.08
PD-L1:
0%
≥1%

50/378 (13.2)
50/381 (13.1)
0.97
BMI:
<30
≥30

100/756 (13.2)
34/210 (16.2)
0.27
Insurance:
Medicaid, self-pay, unknown insurance
Others

19/150 (12.7)
115/816 (14.1)
0.64
Smoking:
Never-smoker
Ever-smoker

24/108 (22.2)
110/858 (12.8)
0.01
Year:
2019
2020

84/508 (16.5)
50/458 (10.9)
0.01

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Care Delivery and Regulatory Policy

Track

Care Delivery and Quality Care

Sub Track

Care Delivery

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr e13509)

DOI

10.1200/JCO.2023.41.16_suppl.e13509

Abstract #

e13509

Abstract Disclosures