Medicare-Insured Patients With Advanced Lung Cancer Have Worse Survival

Older patients with advanced non-small cell lung cancer (NSCLC) who are Medicare-insured tend to have shorter overall survival (OS) compared with patients observed in registrational clinical trials, according to recent research.

The study, which was published in JAMA Oncology, was intended to further the understanding of treatment patterns associated with older patients with advanced NSCLC who receive Medicare coverage, because the knowledge of immunotherapy uptake and effectiveness is lacking in this population outside of clinical trials.

“Because most of the approximately 230,000 patients diagnosed with lung cancer each year in the U.S. are eligible for Medicare, understanding practice pattern trends and outcomes associated with introduction of (Keytruda; pembrolizumab) therapy in the Medicare-insured populations is important,” the study authors wrote. “Such data may inform prognostic discussions in clinical practice; moreover, evaluation of Medicare claims may expeditiously identify subgroups who obtain unusually large or small survival benefits from treatment.”

The researchers conducted a retrospective study using data from the Centers for Medicare and Medicaid Services. They analyzed 19,529 Medicare-insured patients between the ages of 66 and 89 who had advanced NSCLC and received a first-line systemic therapy regimen. The regimens included Keytruda (pembrolizumab), platinum/pemetrexed chemotherapy, platinum/taxane chemotherapy or platinum/pemetrexed/Keytruda chemoimmunotherapy.

The uptake of the regimens that included immunotherapy was rapid within the Medicare population – it increased from 0.7% of first-line treatments in 2016 to 42.4% in 2018. Older patients (defined as 70 and above) had higher risk stratification scores, meaning a higher burden of comorbid illnesses, and were more likely to received immunotherapy than chemotherapy.

Survival among patients receiving Keytruda was approximately 15 months shorter than reported in the clinical trial, KEYNOTE-024. Among patients receiving the platinum/pemetrexed/Keytruda chemoimmunotherapy, survival was approximately 10 months shorter than reported in the KEYNOTE-189 clinical trial.

“Medicare claims are an expedient source of current data that can be used to identify emerging patterns of care and to generate hypotheses about subgroups at risk for particularly small or large benefit,” the authors wrote. “Descriptions of care in the Medicare population can then be used to prioritize focus in studies that use more granular data sources, such as electronic health records or even linkages between these data and molecular profiles from next-generation sequencing.”

They added that the results may inform prognostic considerations in practice and reinforce the importance of patient selection dynamics when assessing treatment strategies.

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