'Concerning' Low Rates of Durvalumab Maintenance Therapy in NSCLC in US

By Megan Brooks

September 16, 2021

NEW YORK (Reuters Health) - Many patients with unresectable stage-III non-small-cell lung cancer (NSCLC) in the United States are not receiving standard-of-care durvalumab maintenance therapy, according to a review of insurance claims.

The rate of utilization of maintenance durvalumab utilization was "pretty low - lower than what we expected," said Dr. Jason Liu with City of Hope National Medical Center, in Duarte, California, in a presentation of the results at the World Conference on Lung Cancer (WCLC) 2021, hosted by the International Association for the Study of Lung Cancer (IASLC).

"If we're able to increase utilization rates, hopefully we'll see an associated improvement in oncologic outcomes as a result since all patients would be getting the gold-standard treatment," Dr. Liu said.

In February of 2018, the U.S. Food and Drug Administration (FDA) approved durvalumab maintenance therapy for unresectable stage-III NSCLC based on results of the PACIFIC trial which demonstrated an overall survival and progression-free survival benefit. The drug has now become standard of care.

Dr. Liu and colleagues assessed durvalumab utilization rates for the period February 2018 through November 2020 by analyzing open claims, using IQVIA pharmacy and medical claims data, and adjudicated closed claims data from IQVIA PharMetrics Plus Health Plan Claims Database.

Among 8,071 NSCLC patient records from the open claims source, only 1,794 (22.2%) received maintenance durvalumab. Baseline characteristics were similar in durvalumab users and non-users.

Durvalumab use was higher in patients aged 65 and older and those treated in the Midwest.

In the closed claims data source, only 127 of 357 (35.6%) patients received maintenance durvalumab.

"Something surprising that we found was that the rate of maintenance pembrolizumab was higher than what we expected at around 25%, both in the open and closed claims database, which raises further questions about practice patterns in the United States," Dr. Liu told the conference.

"Patients also had a high rate of not getting any maintenance therapy, about 30% in both databases as well," he noted.

Weighing in on this study, Erica Hlavacek, a patient advocate who has been living with stage-IV lung cancer for four years, said she has "benefited from cutting-edge care, including having biomarker testing at diagnosis and recurrences."

Hlavacek said she's worked through two tyrosine kinase inhibitors (TKIs) and is currently on a chemotherapy regimen, while she awaits entry into her first clinical trial in October.

"While I have been lucky in receiving cutting-edge care, over and over, I see the standard of care not reaching every patient, and some patients not even knowing a higher level of care exists unless they're lucky enough to be treated at the right center," she added.

"There is a family behind every patient that could have had a different treatment, that could have had more options, that could have had a better outcome. We know the gaps exist, what we do to change it is the question," Hlavacek commented.

The finding that less than 40% of patients are receiving the standard of care durvalumab following chemoradiation is "concerning when we know there are better outcomes using the FDA-approved regimen," she told the briefing.

"Equally concerning is 30% of patients receiving no maintenance therapy, and 25% receiving an alternative therapy. This goes back to the idea of where you live determines if you live and we must do better at ensuring that the correct treatment is finding the patients," Hlavacek said.

"As a patient advocate, I see this as one of the key issues of disparities. How do we bridge this gap to ensure that the industry's amazing breakthroughs and continuous FDA approvals are reaching all of the institutions and oncologists so that all patients receive cutting-edge care," she concluded.

The study had no commercial funding. Dr. Liu has no relevant disclosures.

SOURCE: https://wclc2021.iaslc.org/ (IASLC) 2021 World Conference on Lung Cancer, presented September 9, 2021