Real-world use of durvalumab for patients with unresectable, stage III non-small cell lung cancer in the United States Veterans Health Administration

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2022-08-11

Authors

Moore, Amanda Marie

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Abstract

The approval of durvalumab, an immune checkpoint inhibitor, for the treatment of non-small cell lung cancer (NSCLC) was based on the landmark PACIFIC trial and created a paradigm shift in the treatment landscape of unresectable, stage III NSCLC. Despite robust clinical trial data, however, limited real-world data exists regarding the use of durvalumab in clinical practice. Real-world evidence is an increasingly important tool used to understand the clinical use of a drug in a typical patient population outside of the controlled environment of a randomized interventional trial. Real-world studies are also useful in the analysis of health disparities in patient subpopulations that are typically underrepresented or excluded from clinical trials, including pregnant women, racial and ethnic minorities, and patients of advanced age. Despite efforts from governmental agencies to increase enrollment of racial and ethnic minorities in clinical trials, there is still a lack of representation by these groups in clinical studies. Notably, Black patients are underrepresented in clinical trials for the approval of immunotherapies in NSCLC, despite Black males having the highest incidence and mortality rates for lung cancer across all reported races and ethnicities in the United States. This study aimed to use real-world data of patients with unresectable, stage III NSCLC treated with durvalumab at the Veterans Health Administration (VHA) to 1) describe durvalumab treatment patterns, including treatment initiation delays, interruptions, and discontinuations, and the reasons for such, and 2) identify racial disparities in durvalumab treatment patterns between Black and white patients. Patients were identified using criteria applied to the VHA electronic health record and confirmed for inclusion by manual chart review. Overall, nearly two-in-five patients had delayed initiation of durvalumab, about one-in-five experienced a treatment interruption, and more than half of the patients permanently discontinued durvalumab before completing planned therapy. There were no significant differences in treatment patterns between Black and white patients, although a higher proportion of Black patients experienced treatment initiation delays and interruptions. These results highlight the VHA as an equal-access healthcare system, but may suggest that patients from historically neglected communities could benefit from additional support systems that increase access to care.

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