Utilization patterns of immune checkpoint inhibitors (ICI) for non-small cell lung cancer (NSCLC) within the veterans health administration (VHA).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e21630-e21630
Author(s):  
Drew Moghanaki ◽  
Renjian Jiang ◽  
David Gutman ◽  
Abigail Burns ◽  
Vidula Sukhatme ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Checkpoint Inhibitors ◽  
Stage Iv ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Small Cell Lung ◽  
Integrated Healthcare ◽  
Utilization Patterns ◽  
Multivariable Analyses

e21630 Background: ICI are used routinely for treatment of lung cancer. We investigated the utilization of PD-1/PD-L1 inhibitors for NSCLC in the VHA. Methods: The VHA Corporate Data Warehouse was queried for data on ICI utilization in NSCLC [IRB #00113521]. The first date of any ICI dispensed was January 6, 2015 and therefore this investigation evaluated all patients diagnosed with NSCLC between 2015 –2019. Results: A total of 27,586 Veterans were diagnosed with NSCLC during the study period with demographics: 76.3% Caucasian, 16.3% black; 97.0% male; median age 71 years. Stage distribution was 27.9%, 7.9%, 15.8%, and 27.0% for stage I, II, III, or IV, respectively. A total of 3,990 patients were identified to have received any ICI, representing 20.1% of patients diagnosed with stage IV; 159 patients received more than one ICI. The median time from stage IV diagnosis to receipt of ICI was 5 months (IQR: 2-9 months). ICI was dispensed in 83.7% for duration of < 1 year, 13.3% for 1-2 years, and 3% for > = 2 years. The median duration of ICI receipt (with IQR in months): Nivolumab = 2.0 (0.5-5.5), Pembrolizumab = 2.1 (0.3-5.9), Durvalumab = 5.1 (1.8-9.2), and Atezolizumab = 0.3 (0.1-2.1). Multivariable analyses demonstrated female, not married, 0 comorbidity, and higher stage (II-IV) were independently associated with shorter time to receipt of ICI. Conclusions: The use of ICI for NSCLC is increasing within this integrated healthcare system and commonly prescribed within 5 months of stage IV diagnosis. Further investigations of this cohort using available clinical, pharmaceutical, and genomic data within the VHA present an opportunity to enhance our understanding of the efficacy of ICI for NSCLC. [Table: see text]

Effect of antibiotic therapy on immunotherapy outcomes for non-small cell lung cancer: Analysis from the Veterans Health Administration Database.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 9017-9017
Author(s):  
William A. Stokes ◽  
Madhusmita Behera ◽  
Renjian Jiang ◽  
David Gutman ◽  
Felipe Giuste ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Antibiotic Therapy ◽  
Small Cell Lung Cancer ◽  
Veterans Health Administration ◽  
Small Cell ◽  
Matched Cohort ◽  
Veterans Health ◽  
Health Administration ◽  
Small Cell Lung ◽  
Nsclc Patients

9017 Background: Dysregulation of the gut microbiota induced by antibiotic therapy (Abx) may alter the anticancer immune response. Multiple small studies have associated Abx use with inferior immune checkpoint inhibitor (ICI) efficacy in patients with non-small cell lung cancer (NSCLC). We aimed to study the impact of Abx in a larger population of NSCLC patients treated with ICI within the Veterans Health Administration. Methods: We conducted a nested cohort study of Veterans who were diagnosed with NSCLC between 2010 & 2018 and treated with ICI. Two exposures to Abx were specified and separately analyzed: prior Abx (pAbx) was defined as receipt of an Abx prescription within 30 days prior to initiation of ICI, and concurrent Abx (cAbx) was defined as receipt of an Abx prescription within 60 days following ICI initiation. A landmark analysis of 2 months from ICI start was applied to the cAbx analysis to exclude any Veterans with an OS event before that time point. OS was measured from start of ICI using Cox proportional hazard multivariate analyses (MVA). Results: 3,634 Veterans received ICI, mostly nivolumab (59.3%) or pembrolizumab (35.1%). Their median age was 69, and a plurality had male gender (97.0%), white race (73.0%), comorbidity count ≥1 (60.4%), adenocarcinoma (47.8%), and stage IV disease at diagnosis (40.9%). Of the 762 (21.0%) Veterans prescribed pAbx, beta-lactams, quinolones, and macrolides were the most common classes. These patients had shorter OS than those without pAbx (median 7 versus 10 months). Receipt of pAbx was also associated with lower OS on MVA (HR 1.31, p<0.01). In the propensity-matched cohort analysis, Veterans receiving pAbx had lower OS (HR 1.27, p<0.01) (Table top). For the cAbx analysis, 3,223 Veterans survived to the 2-month landmark, of whom 970 (30.1%) received cAbx. These Veterans had shorter OS than those without cAbx (median 7 versus 10 months). Lower OS with cAbx was also observed both on Cox MVA (HR 1.33, p<0.01) and in the matched cohort (HR 1.32, p<0.01) (Table bottom). Conclusions: In the largest analysis to date of Abx use in NSCLC patients receiving ICI, receipt of Abx within either 30 days before or 60 days after start of ICI was associated with lower OS. These findings suggest Abx therapy may have a detrimental effect on immunotherapy outcomes.[Table: see text]

scholarly journals National Trends in End-of-Life Care for Veterans With Advanced Cancer in the Veterans Health Administration: 2009 to 2016

2019 ◽  
Vol 15 (6) ◽  
pp. e568-e575 ◽  
Author(s):  
Claire E.P. Smith ◽  
Arif H. Kamal ◽  
Monica Kluger ◽  
Patty Coke ◽  
Michael J. Kelley
Keyword(s):  
Lung Cancer ◽  
End Of Life ◽  
Analysis Of Variance ◽  
Stage Iv ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Icu Admission ◽  
Stage Iv Lung Cancer ◽  
Hospice Use

PURPOSE: It is imperative to provide quality end-of-life (EOL) care for patients with cancer. Although rates of hospice use within the Veterans Health Administration have improved, antineoplastic administration and intensive care unit (ICU) admission at the EOL, indicators of aggressive care, have not clearly declined over recent years. METHODS: We identified 32,665 veterans diagnosed with stage IV lung, colorectal, or pancreatic cancer who died between 2009 and 2016 using a novel EOL Dashboard Tool created from Veterans Administration Cancer Registry data. This EOL tool reports the incidence of antineoplastic drug use in the last 14 days of life, ICU admission in the last 30 days of life, and hospice admission or consult. Change from 2009 to 2016 was assessed using a repeated measures one-way analysis of variance with post hoc test for linear trend of time for individual cancers and two-way analysis of variance for all cancers combined. RESULTS: Antineoplastic use in the last 14 days of life declined from 6.8% in 2009 to 4.4% in 2016 ( P = .03). ICU admission in the last 30 days did not change significantly, from 13.3% in 2009 to 14.7% in 2016. The exception was patients with stage IV lung cancer, in whom ICU admissions increased from 12.9% to 16.2% ( P = .01). Patients using hospice services increased from 32.4% to 52.6% ( P < .01). CONCLUSION: Although antineoplastic administration at the EOL is declining for veterans with stage IV cancer, ICU admissions are unchanged and becoming more common in stage IV lung cancer despite increasing hospice use.

Improved survival of small cell lung cancer in the veterans health administration from 2000-2010: Association with increasing utilization of PET staging.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. e20571-e20571
Author(s):  
Julian C. Hong ◽  
Matthew Boyer ◽  
Daphna Spiegel ◽  
Christina D. Williams ◽  
Betty Caroline Tong ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Veterans Health Administration ◽  
Small Cell ◽  
Veterans Health ◽  
Health Administration ◽  
Small Cell Lung
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