Medicare-Insured Patients With Advanced Lung Cancer: Does First-Line Immunotherapy Improve Survival?
Posted: Tuesday, July 20, 2021
According to research published in JAMA Network Open, checkpoint inhibitor immunotherapy may be associated with shorter overall survival in older patients with advanced non–small cell lung cancer who were insured by Medicare. Deborah Schrag, MD, of the Dana-Farber Cancer Institute, Boston, and colleagues noted that immune checkpoint inhibition is commonly indicated for treatment of lung cancer, yet its role in older patients outside of clinical trials remains unclear.
The retrospective cohort study included 19,529 Medicare-insured patients (54% male; median age, 73.8 years) with advanced lung cancer who had undergone initial palliative-intent systemic therapy between January 1, 2016, and December 31, 2018. Recorded treatment regimens included pembrolizumab monotherapy (n = 3,079); combined platinum-based regimens, such as cisplatin or carboplatin, and pemetrexed disodium (n = 5,159); combined platinum and a taxane, such as paclitaxel, nab-paclitaxel, or docetaxel (n = 9,866); and combined platinum, pemetrexed, and pembrolizumab (n = 1,425). The frequency of pembrolizumab-containing treatment regimens among this population increased rapidly, growing from 0.7% of all initial treatments in the second quarter of 2016 to 42.4% in the third quarter of 2018.
Among patients receiving pembrolizumab monotherapy, the unadjusted median survival was 11.4 months, roughly 15 months shorter than that observed in the KEYNOTE-024 trial. The unadjusted median survival among those receiving platinum/pemetrexed/pembrolizumab treatment was 12.9 months, roughly 10 months shorter than that noted in the KEYNOTE-189 trial. Adjusted survival was similar between patients treated with pembrolizumab and those treated with platinum/pemetrexed or platinum/taxane as well as between those treated with platinum/pemetrexed/pembrolizumab and those receiving platinum/pemetrexed.
“These results may inform prognostic considerations in practice and reinforce the importance of understanding patient selection dynamics in assessing the value and clinical utility of transformative treatment strategies,” concluded the study authors.
Disclosure: For full disclosure of the study authors, visit jamanetwork.com.