51P Shortcomings of immuno oncology (IO) agents application into real-world practise due to financial constraints in a resource constrained setting

Abstract

Indications of IO have been on the rise with growing data across different cancers ranging from metastatic to earlier stages. However, applicability of the same into real world practise is limited in lower middle income countries due to financial constraints. Data is lacking in this regard. We conducted an observational study at our center to see applicability of IO indications across different cancers. Consecutive patients between Jan 2018 and Feb 2020 who had an indication for IO usage were enrolled and their treatment regimens studied. Patients across different primary sites were included with approved IO regimen .Reasons for non usage of IO were studied. Between Jan 2018 and Feb 2020 ,374 patients were enrolled who were eligible for treatment with IO either as a single agent or as combination .The most common indication was metastatic NSCLC (22.4%),head & neck (17.1%),RCC (11.2%) ,bladder (10.1%), endometrium (9.6%) ,HCC (10.1%) ,Hodgkins lymphoma (4.2%),melanoma (3.7 %) stage 3 NSCLC (5.3%) and so on .Of 374 patients ,only 114 (30.4%) were finally treated with IO regimen .The most common reason for non usage was financial constraints (80.7%) which included exhaustion of insurance limit ,denial by insurance company (11.5%) and non availability of drug (7.6%) .Of the 114 patients who were treated ,26.3% had to withdraw the drug owing to financial toxicity while the disease was still responding with the median time to withdrawal being 6.4 months. Our study depicts a real-world picture of practical difficulties in treating with approved regimens with financial constraints leading to non usage/withdrawal of drug in nearly 65% patients. This issue needs to be addressed if more patients are to be benefitted from IO agents in the future in lower middle income countries like India.