Patterns of care in Medicaid-enrollees with recurrent or metastatic cervical cancer.

Abstract

e17525 Background: Cervical cancer remains a disease with high unmet need, and a large proportion of patients are insured through Medicaid (̃30%). Previous real-world studies demonstrated significant variability in treatments for recurrent or metastatic cervical cancer (r/mCC) patients following doublet chemotherapy ± bevacizumab, despite the 2018 approval of pembrolizumab in PD-L1+ r/mCC. As r/mCC treatment landscape continues to evolve, there is a need to understand current real-world unmet need among Medicaid r/mCC patients. This study aims to evaluate treatment patterns and healthcare resource utilization (HCRU) among Medicaid-insured r/mCC patients. Methods: This is a retrospective analysis of nationwide Medicaid claims to assess patient characteristics, treatment patterns, and HCRU among r/mCC patients between 2016-2019 (most recent Medicaid data available). First line treatment (1L) for r/mCC was identified as the first administration of systemic therapy without concomitant radiation or surgery. Patient characteristics, treatment patterns, and HCRU were characterized by line of therapy. Results: A total of 2,741 adult females initiated systemic treatment for r/mCC between 2016–2019, mean age was 52.8 (SD = 12.8), and most patients were enrolled in comprehensive managed care plans (58%). Over 41% (N = 1,145) had evidence of second line treatment (2L), with over one third (N = 385) of those also having evidence of third line treatment (3L). Consistent with treatment guidelines, the majority (61%) of 1L regimens were doublet chemotherapy ± bevacizumab. In contrast, no clear standard of care was observed among patients receiving 2L or 3L therapy. Notably, immunotherapy accounted for 22% of treatment regimens in 2L/3L overall, with its use increasing significantly over time (< 6% in 2016 to 41% in 2019; p-value < 0.001); however, despite availability of immunotherapy, most patients did not remain on treatment for a prolonged duration (immunotherapy median duration 2.2 months vs. 2.5 months for non-immunotherapy, p-value = 0.9). Across all HCRU measures (inpatient admissions, outpatient visits, emergency visits, and pharmacy claims), 2L/3L patients had less utilization per patient, compared with 1L patients. Conclusions: There was no clear standard of care for 2L+ r/mCC patients enrolled in Medicaid treated between 2016-2019. Although immunotherapy use is increasing, there is still high medical unmet need based on short durations of treatment and poor historical outcomes. New therapies should provide meaningful clinical benefit without significant increase in HCRU.