Factors associated with receipt of second-line recurrent or metastatic cervical cancer treatment in the United States: A retrospective administrative claims analysis.

Abstract

5532 Background: There is limited real-world data on the proportion of eligible patients who received second-line (2L) treatment following progression on first-line (1L) systemic therapy for recurrent or metastatic cervical cancer (r/mCC). In addition, factors impacting selection of 2L are not well-understood. The objective of this study was to determine the prevalence and predictors of subsequent therapy among patients with 1L-treated r/mCC. Methods: We conducted a retrospective analysis of the 2015-2020 MarketScan claims database. Women ≥18 years of age with at least one inpatient claim or two outpatient claims with a diagnosis for malignant neoplasm of the cervix followed by 1L therapy codes were identified. The last recorded date of 1L treatment was assigned as the index date for each woman. Continuous enrollment criteria of minimum 3-month pre-index and 12-month post-index were applied. Women with claims for a new therapy after 60 days but no later than 365 days from the end of 1L treatment were identified as those who continued r/mCC treatment. We used descriptive statistics to examine the baseline characteristics of the final analytical cohort. A multivariable logistic regression model examined the factors associated with treatment discontinuation. All analyses were performed using SAS, Cary, NC. P-value was tested at 0.05. Results: A total of 1,080 patients with 1L-treated r/mCC were identified, of whom 384 met the study criteria. Post-1L treatment, 196 (51.0%) patients received a new therapy within a median duration of 122 days. A total 188 (49.0%) patients did not receive subsequent therapy. The geographic location of patient (identified based on census region as Northeast, Midwest, South, or West) and prior bevacizumab exposure were significant predictors of receiving subsequent therapy. Specifically, patients from the Midwest (odds ratio [OR] = 0.43; 95% CI: 0.23-0.84) and Southern (OR = 0.53; 95% CI: 0.29-0.96) regions had lower likelihood of receiving 2L treatment after 1L, compared to those living in the Northeast. Women without prior bevacizumab treatment were also less likely to receive subsequent therapy (OR = 0.65; 95% CI: 0.42-0.99). Age, type of health plan, and comorbidities were not associated with the likelihood of receiving subsequent treatment. Conclusions: Overall, nearly half of the 1L-treated r/mCC patients did not continue to 2L therapy, with findings showing treatment drop-off differing significantly by geographic region and prior treatment. Additional research and targeted outreach efforts are needed to understand geography-, population-, or practice-specific barriers impacting access to therapy among r/mCC patients.