Authors:
Background:Ram+docetaxel & ICIs are FDA-approved for aNSCLC pts failing Pt therapy. Optimal sequencing of these regimens is unknown. The study objective was to evaluate sequence patterns and outcomes with ram used pre v post-ICI in unmatched Pt-treated aNSCLC pts in the US.Methods:aNSCLC pts who initiated ram in 2L or 3L between March 2015 - May 2017, after 1L or 2L Pt therapy with ≥ 3 months of potential follow-up, and were treated with ICIs were identified in the Flatiron Health EHR-derived database. Overall survival (OS) was indexed to start of 1L and real-world progression-free survival (rwPFS) was indexed to start of 2L or 3L ram. Unadjusted hazard ratios (HR) were calculated using Cox models.Results:Of 185 eligible pts, 57% were treated with sequences including ram & ICIs. Of these, 38% and 62% received ram pre-ICI or post-ICI, respectively. Characteristics for ram pre & post-ICI pts shown in Table. All ram post-ICI pts received ram in 3L. Ram pre-ICI pts mostly (67%) initiated ram in 2L. While not statistically significant, pts receiving ram pre-ICI (reference) had longer median OS (24.0 v 19.0 months; HR = 1.30, 95% CI: 0.78 - 2.15) than ram post-ICI pts. Median rwPFS was similar (3.87 v 3.61 months; HR = 0.97, 95% CI: 0.63 - 1.47), as was ram therapy duration (2.8 v 2.4 months, log-rank P = 0.71).Conclusions:In this real world study, ram was most often used in 3L after an ICI. A trend for longer OS was observed in pts treated with ram pre-ICI, suggesting that the sequence for ram & ICIs may be important. However, this study was not large enough to support definitive conclusions in light of limited sample size and the potential impact of baseline characteristic imbalances; thus current findings warrant further study.
Sources:
ASCO Annual Meeting