Shifts in treatments of advanced-stage non-small cell lung cancer (NSCLC) have resulted in survival and spending gains over time, according to a report published in the Journal of Clinical Oncology.
-----
Related Content
Novel Biomarker Predicts Treatment Response in NSCLC
Quality Measures for NSCLC Significantly Improve Survival
-----
The US Food and Drug Administration has approved several infusion and oral antineoplastic agents in the past decade for the treatment of newly diagnosed, advanced-stage NSCLC. In a retrospective study, researchers led by Cathy J Bradley, PhD, Department of Health Systems, Management, and Policy, University of Colorado, sought to examine trends in the use of these new agents as well as resulting changes in spending and effects on survival.
Researchers used SEER-Medicare data for elderly patients (≥65 years) with a new diagnosis of advanced-stage NSCLC between 2000 and 2011 who were treated with antineoplastic agents (N = 22,163). Identified antineoplastic agents included cisplatin, carboplatin, paclitaxel, docetaxel, vinorelbine, gemcitabine, etoposide, irinotecan, pemetrexed, bevacizumab, and erlotinib. Patient data over a 12-year period was reviewed to estimate the adjusted percentage of patients with advanced-stage NSCLC who received each antineoplastic agent, days while on treatment, survival, and spending in the 12-months after initial diagnosis.
Results of the study showed a shift in preferred treatment toward pemetrexed (39.2%), erlotinib (20.3%), and bevacizumab (18.9%). Paclitaxel (38.7%), gemcitabine (17.0%), and vinorelbine (5.7%) declined in treatment use. Average total days on therapy increased from 103 days to 108 days. Patients who received the aforementioned preferred treatments had the longest average treatment durations (146 days vs 75 days for those receiving other agents).
During the year after initial diagnosis in the 12-year time frame, acute inpatient spending declined by approximately $6000 per patient, while outpatient spending increased by approximately $9000 per patient (23%). Median survival gains of 1.5 months (P < 0.001) were calculated over the 12-year span.
Researchers concluded that considerable shifts in advanced-stage NSCLC treatment has occurred in the past decade, along with modest gains in survival and Medicare spending. While these findings have clinical and policy relevance, researchers acknowledge that further outcomes research is required in order to inform value-based treatment decisions for advanced-stage NSCLC.
