Study discussant Jyoti Patel, MD, Medical Director of Thoracic Oncology and Assistant Director for Clinical Research at the Lurie Cancer Center of Northwestern University, Chicago, called the research “important for many reasons.” Although the study analyzed data from both open and closed claims, Dr. Patel said the latter, which showed 35.6% of patients received maintenance durvalumab, is “probably closer to the actual rates of utilization.”
“In the best-case scenario, just over one-third of patients received standard-of-care durvalumab after chemoradiation,” she said. “In the worst case, however, that rate fell to approximately one-quarter of patients.”
Regarding the one-third of patients who received maintenance chemotherapy, Dr. Patel said there are no data to support this treatment, given the results of the PACIFIC study and the approval of durvalumab. Similarly, pembrolizumab is not approved in this setting.
Jyoti Patel, MD
‘Eye-Opening’ Outcomes From Web-Based Survey
To understand why so many patients received “inferior therapy,” Dr. Patel looked to the “eye-opening” outcomes of a Web-based survey of U.S. oncologists. The survey findings revealed that up to 64% of oncologists believe many patients are “unlikely to tolerate concurrent chemoradiation due to comorbidities, performance status, or advanced age.”1 Responding oncologists also thought that “many patients did not want concurrent therapy,” because of the presence of a targetable mutation, the inability to travel to receive chemotherapy or radiation, or the high cost of treatment.
According to Dr. Patel, the survey showed that just 55% of oncologists would routinely recommend immunotherapy after concurrent chemoradiation. “Oncologists who responded to the survey highlighted both patient factors and systemic barriers to the utilization of immunotherapy,” she shared. “Although some patients refused immunotherapy due to affordability, travel, and/or side effects, up to 20% of patients had disease progression after chemoradiation or had decline in performance status.”
Other biologic factors included PD-L1–negative tumors or the presence of targetable mutations, such as EGFR. In addition, oncologists reported challenges with insurance preauthorization.
“Unfortunately, many patients have a poor performance status or multiple comorbidities that preclude the delivery of concurrent chemoradiation,” Dr. Patel concluded. “There are also lingering questions about the biology of the disease and the unclear benefit of immunotherapy in patients who may be PD-L1–negative or have targetable mutations.”
DISCLOSURE: Dr. Patel has served on the advisory board of AstraZeneca and Takeda.
REFERENCE
1. Cotarla I, Boron ML, Cullen SL, et al. Treatment decision drivers in stage III non-small-cell lung cancer. JCO Oncol Pract 16:e1232-e1242, 2020.
