Electronic patient-reported outcomes in a cohort of patients with lung cancer treated in the community with shorter versus longer course PD1/PDL1 therapy.

Abstract

e18810 Background: PD1/PDL1 (IO) therapy has been extensively studied as monotherapy and in combination with other IO therapy, chemotherapy and targeted agents. The side effect profile in the clinical trial setting in lung cancer has been extensively cataloged. However, patient-reported symptoms in the real world have not been evaluated and may help inform reasons for patient discontinuation of therapy or adverse clinical events. Methods: Patients from 3 community oncology practices were eligible for inclusion in the study if they had a primary diagnosis of lung cancer, started IO therapy (either monotherapy or in combination with chemotherapy) between Sep 2020 and June 2022 (with follow-up through Dec 31, 2022), and submitted at least 2 ePRO reports during treatment. We examined ePRO reports submitted by patients using a proprietary commercially available ePRO tool. Reports were categorized as high risk if they exceeded a clinical threshold for severity defined by the practices. We also examined the reporting profile by therapy type, and further stratified by time on treatments ( < 6 versus 6+ months of therapy). Results: There were 172 patients included in the analysis. Over this time frame, 68 patients received IO monotherapy and 104 received IO plus chemotherapy. Of these patients, 51% were male and 64% were 65+ years of age. Overall, 68 patients received less than 6 months of therapy and 104 patients received more than 6 months of therapy. There were 3159 reports submitted (1087 within the first 60 days of treatment) with a median of 13 reports per patient. Patients receiving IO plus chemotherapy reported more severe symptoms (symptom severity of 3 or greater on a 5-point scale) within the first 60 days of treatment than those receiving IO monotherapy (51% vs 34%, p = 0.03, Chi square). Regardless of treatment type, patients receiving < 6 months of therapy were more likely to report severe symptoms during this time period as compared to those on treatment for 6 months or longer (Table). 50% of reports triggered an alert based on severity, 22% led to a phone call and 1.3% an emergent office visit. Conclusions: ePROs can identify common side effects in lung cancer patients receiving IO monotherapy and IO/chemotherapy combinations. Early symptoms may define a population at high risk of early discontinuation. Aggressively managing these patients might result in a longer duration of therapy and better clinical outcome. [Table: see text]