Factors associated with the use of immune checkpoint inhibitors in older adults with metastatic non-small cell lung cancer and pre-existing autoimmune disease: A SEER-Medicare study
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引用次数: 0
Abstract
Introduction
The presence of pre-existing autoimmune disease (PAD) with metastatic non-small cell lung cancer (mNSCLC) poses challenges in the use of immune checkpoint inhibitors (ICI). This study investigated factors influencing ICI utilization in older adults with mNSCLC and PAD.
Materials and Methods
A retrospective cohort study with a 12-month baseline prior to treatment initiation was conducted using the SEER-Medicare data. Patients aged 66 years and above diagnosed with mNSCLC between January 2015 and December 2017, who initiated immunotherapy only/chemoimmunotherapy (IT/CIT) or chemotherapy only (CIT) and had at least one PAD diagnosed any time before treatment initiation, were included. Multiple factors, guided by the Model of Health Services Utilization, were analyzed using multivariable logistic regression. Adjusted odds ratios (aORs) and 95.0% CIs were reported.
Results
Among 1,319 patients initiating first-line (1L) systemic therapy, 22.3% received IT/CIT and 77.7% received CT. Patients initiating IT/CIT were more likely to be 76–80 years old (aOR = 1.70, 95.0% CI = 1.02–2.81) and > 80 years old (aOR = 2.49, 95.0% CI = 1.46–4.25), reside in South (aOR = 2.32, 95.0% CI = 1.36–3.96) and West (aOR = 2.27, 95.0% CI = 1.44–3.60) SEER regions, diagnosed in 2016 (aOR = 6.36, 95.0% CI = 3.06–13.22) and 2017 (aOR = 40.45, 95.0% CI = 19.70–83.07), having a longer time to treatment initiation (aOR = 1.14, 95.0% CI = 1.08–1.19), having non-squamous tumor histology (aOR = 1.511, 95.0% CI = 1.048–2.179), and having a prior hospitalization (aOR = 1.63, 95.0% CI = 1.14–2.33). These patients were less likely to have recently used an immunosuppressant (IS) (aOR = 0.06, 95.0% CI = 0.04–0.10).
Discussion
Several factors, such as age, region, cancer diagnosis year, time to treatment initiation, and recent IS use, intricately shape treatment decisions. Further in-depth research on each of these factors is imperative to optimize strategies for this distinctive patient population.
期刊介绍:
The Journal of Geriatric Oncology is an international, multidisciplinary journal which is focused on advancing research in the treatment and survivorship issues of older adults with cancer, as well as literature relevant to education and policy development in geriatric oncology.
The journal welcomes the submission of manuscripts in the following categories:
• Original research articles
• Review articles
• Clinical trials
• Education and training articles
• Short communications
• Perspectives
• Meeting reports
• Letters to the Editor.