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249 Characterization of unresectable and/or metastatic solid tumors patients treated with systemic anticancer therapy in first-line settings: a pan-tumor community-oncology based study
  1. Elise Wu1,
  2. Sneha Sura2 and
  3. Alexander Spira3
  1. 1Merck and Co., Inc., Kenilworth, NJ, USA
  2. 2McKesson Life Sciences, The Woodlands, TX, USA
  3. 3Texas Oncology, Fairfax, VA, USA


Background Since the introduction of immunotherapy (I/O) in 2014, increasing number of patients with solid tumor are treated with I/O. This study aimed to describe demographic and clinical characteristics of patients initiating I/O versus non-I/O-based systemic anticancer therapy (SACT) in the first-line (1L) settings among patients diagnosed with unresectable and/or metastatic solid tumors in a real-world US community oncology setting from pan-tumor perspective.

Methods This retrospective observational study used the US Oncology Network’s iKnowMed electronic health record database and included adults diagnosed with unresectable and/or metastatic solid tumors who initiated SACT. We selected 11 solid tumors in the cohort because I/O has been approved as 1L treatment for unresectable and/or metastatic tumors prior to August 2019. We included I/O indicated patients who initiated either 1L I/O or non-I/O-based SACT between 01/01/2014 and 08/31/2019. All analysis was performed based on pan-tumor perspective with no stratification by tumor types. Descriptive statistic was conducted to characterize demographic and clinical characteristics among those who used I/O versus non-I/O-based SACT.

Results A total of 20,057 patients were included in the study cohort. 5,119 (25.5%) used I/O and 14,938 (74.5%) used non-I/O-based SACT. The use of I/O increased from 4.0% in 2014 to 66.3% in 2019 with a corresponding decline in non-I/O use during the same period. Patients who initiated I/O were older (69.4 vs. 67.8 years, p<0.0001), and a greater proportion were male (57.8% vs. 53.0%, p<0.0001) and had Medicare insurance (57.0% vs. 55.2%, p=0.025) compared to those who initiated non-I/O-based SACT. Race distribution and smoking status were significantly different between I/O users and non-users (p<0.0001 for both). The mean duration of time from unresectable and/or metastatic solid tumors diagnosis to SACT initiation was higher in I/O users compared to non-I/O-based SACT users (10.1 weeks vs. 6.1 weeks, p<0.0001). Among clinical characteristics, a greater proportion of I/O users had ECOG performance status of 3+ (2.1% vs. 1.6%, p<0.0001), lung as a site of metastases(13.9% vs. 10.1%, p<0.0001), and had 1+ Charlson comorbidities (19.2% vs. 15.6%, p=0.002).

Conclusions This real-world study provides insight into characteristics of patients with unresectable and/or metastatic solid tumors who initiated SACT in real-world oncology settings. Patients who received I/O appeared to be older, and sicker and takes a longer time to receive treatment since diagnosis compared to those who received non-I/O-based SACT. Future research should carefully adjust patients‘ characteristics while evaluating the effect of I/O therapy on clinical and economic outcomes.

Trial Registration The authors would like to acknowledge Lisa Kaspin-Powell, PhD, ELS, an employee of Ontada, for editorial assistance, which was funded by Merck & Co., Inc.  

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