Differences in prescribing and patient demographics of cki agents among United States patients < 65 and 65+ years old.

Abstract

e14097 Background: Since FDA approval, immune checkpoint inhibitors (CKIs) have become increasingly important in treating NSCLC, particularly among mutation-negative patients who did not benefit from biomarker testing. Because clinical trials typically recruit healthy patients, little information is available to understand the role of CKIs in treating older patients, who also face immunosenescence. This study explores differences in prescribing behavior of CKIs for mutation-negative NSCLC patients < 65 y/o and 65+ y/o in the US and satisfaction with results. Methods: The Ipsos Global Oncology Monitor: an online multi-center medical chart review study of stage IIIb-IV NSCLC patients currently receiving drug treatments seen in consultation from June – November 2018. 170 US physicians provided de-identified data on 1484 patients negative or untested for EGFR, ALK, ROS1 and BRAF. Results: Compared to patients < 65 y/o (n = 539), those 65+ y/o (n = 945) were prescribed a CKI significantly more often, 63% vs 70% (p < 0.01), driven by CKI monotherapy (CKIm) use, 47% vs 55% (p < 0.01). This trend was seen among patients on 1L therapy (n = 1015), with 42% of patients < 65 y/o and 50% of patients 65+ y/o on CKIm (p < 0.05), and on 2L therapy (n = 337), with 62% of patients < 65 y/o and 76% of patients 65+ y/o on CKIm (p < 0.01). In both lines, this was due to more use of nivolumab among 65+ y/o patients (p < 0.01), while among 2L patients < 65 y/o there was also greater use of pembrolizumab (p < 0.05). Physicians’ stated satisfaction with 1L CKI results was similar in both cohorts but, at 2L, greater among patients 65+ y/o (μ = 8.45; σx̅= 1.26) vs patients < 65 y/o (μ = 8.01; σx̅= 1.38) (p < 0.05). Older 2L CKIm patients were more likely to be ECOG 2+ (18% vs 5%; p < 0.01) and to have 2+ concomitant conditions (60% vs 36%p < 0.01). Conclusions: Satisfaction with 2L CKIs is higher in older vs younger patients, despite the former’s association with poorer outcomes. Potentially, lower expectations at treatment initiation caused higher satisfaction for similar treatment success, but this may also be due to immunosenescence, one study suggesting CKIs are more effective in older melanoma patients ( https://dx.doi.org/10.2147%2FOTT.S165368 ). The role of age in CKIs’ efficacy in NSCLC merits further investigation.