Uptake of Adjuvant Chemotherapy for Stage II-IIIA Non-Small-Cell Lung Cancer in the United States
Presented During:
Monday, May 8, 2023: 3:42PM - 3:45PM
Los Angeles Convention Center
Posted Room Name:
Exhibit Hall
Abstract No:
P0149
Submission Type:
Abstract Submission
Authors:
Camille Mathey-Andrews (1), William Pugh (1), Alexandra Potter (1), Arvind Kumar (1), Michael Lanuti (1), Linda Martin (2), Chi-Fu Jeffrey Yang (1)
Institutions:
(1) Massachusetts General Hospital, Boston, MA, (2) University of Virginia Health System, Charlottesville, ID
Submitting Author:
Camille Mathey-Andrews
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Massachusetts General Hospital
Massachusetts General Hospital
Co-Author(s):
William Pugh
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Massachusetts General Hospital
Massachusetts General Hospital
Alexandra Potter
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Massachusetts General Hospital
Massachusetts General Hospital
Arvind Kumar
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Massachusetts General Hospital
Massachusetts General Hospital
*Michael Lanuti
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Massachusetts General Hospital
Massachusetts General Hospital
*Linda Martin
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University of Virginia Health System
University of Virginia Health System
*Chi-Fu Yang
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Massachusetts General Hospital
Massachusetts General Hospital
Presenting Author:
Camille Mathey-Andrews
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Massachusetts General Hospital
Massachusetts General Hospital
Abstract:
OBJECTIVE:
While perioperative immunotherapy has been shown to improve survival in patients with stage II and III non-small cell lung cancer (NSCLC), its relative efficacy in the neoadjuvant vs. adjuvant setting remains unknown. Recently, the ALCHEMIST study attempted to better contextualize the results of adjuvant trials by evaluating the uptake of guideline-concordant adjuvant therapy in patients with NSCLC, finding that only 57% of patients received adjuvant chemotherapy when clinically indicated. Notably, however, this analysis only included clinical trial patients, rendering the real-world uptake of adjuvant therapy still unknown. In this study, we sought to evaluate the use of adjuvant chemotherapy for resected stage II-III NSCLC in the United States using two large, national registries.
METHODS:
Patients in the National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) database with pathologic stage II-IIIA NSCLC resected between 2004-2018 were separately identified. The proportion of patients who received adjuvant chemotherapy, as well as baseline characteristics of patients who did and did not receive adjuvant chemotherapy, were evaluated. Multivariable-adjusted logistic regression was used in the NCDB to identify factors associated with the receipt of adjuvant chemotherapy.
RESULTS:
Of the 38,259 patients with stage II-IIIA NSCLC identified in the NCDB, 20,856 (55%) received adjuvant chemotherapy. Among these patients, 30% with stage IIA, 54% of with stage IIB, and 65% with stage IIIA received adjuvant chemotherapy. Patients who were younger, healthier, recipients of Medicare or private insurance, and who had higher stage or grade tumors were more likely to receive adjuvant chemotherapy than their counterparts. In the SEER database, 26,998 patients with stage II-III NSCLC were identified and 12,582 (47%) received adjuvant chemotherapy. Among these patients, 26% of with stage IIA, 45% with stage IIB, and 55% with stage IIIA disease received adjuvant chemotherapy.
CONCLUSION:
In this national analysis, we found that only ~50% of patients undergoing upfront surgery for stage II-IIIA NSCLC received adjuvant chemotherapy, suggesting that future adoption of adjuvant immunotherapy in real-world settings may be poor. Given the significant survival benefit associated with this treatment, our findings illustrate the need to identify strategies to maximize adoption of immunotherapy in clinical practice.
While perioperative immunotherapy has been shown to improve survival in patients with stage II and III non-small cell lung cancer (NSCLC), its relative efficacy in the neoadjuvant vs. adjuvant setting remains unknown. Recently, the ALCHEMIST study attempted to better contextualize the results of adjuvant trials by evaluating the uptake of guideline-concordant adjuvant therapy in patients with NSCLC, finding that only 57% of patients received adjuvant chemotherapy when clinically indicated. Notably, however, this analysis only included clinical trial patients, rendering the real-world uptake of adjuvant therapy still unknown. In this study, we sought to evaluate the use of adjuvant chemotherapy for resected stage II-III NSCLC in the United States using two large, national registries.
METHODS:
Patients in the National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) database with pathologic stage II-IIIA NSCLC resected between 2004-2018 were separately identified. The proportion of patients who received adjuvant chemotherapy, as well as baseline characteristics of patients who did and did not receive adjuvant chemotherapy, were evaluated. Multivariable-adjusted logistic regression was used in the NCDB to identify factors associated with the receipt of adjuvant chemotherapy.
RESULTS:
Of the 38,259 patients with stage II-IIIA NSCLC identified in the NCDB, 20,856 (55%) received adjuvant chemotherapy. Among these patients, 30% with stage IIA, 54% of with stage IIB, and 65% with stage IIIA received adjuvant chemotherapy. Patients who were younger, healthier, recipients of Medicare or private insurance, and who had higher stage or grade tumors were more likely to receive adjuvant chemotherapy than their counterparts. In the SEER database, 26,998 patients with stage II-III NSCLC were identified and 12,582 (47%) received adjuvant chemotherapy. Among these patients, 26% of with stage IIA, 45% with stage IIB, and 55% with stage IIIA disease received adjuvant chemotherapy.
CONCLUSION:
In this national analysis, we found that only ~50% of patients undergoing upfront surgery for stage II-IIIA NSCLC received adjuvant chemotherapy, suggesting that future adoption of adjuvant immunotherapy in real-world settings may be poor. Given the significant survival benefit associated with this treatment, our findings illustrate the need to identify strategies to maximize adoption of immunotherapy in clinical practice.
Categories:
Lung Cancer
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