Patterns of immunotherapy utilization for non-small cell lung cancer in Texas pre- and post-regulatory approval

• Published in: Clinical & translational oncology 2024-08, Vol.26 (8), p.1908-1920
• Main Authors: Olateju, Olajumoke Adenike, Zeng, Zhen, Zakeri, Marjan, Sansgiry, Sujit S.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - therapy; Drug Approval; Female; Humans; Immunotherapy - statistics & numerical data; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Research Article; Retrospective Studies; Texas; United States; United States Food and Drug Administration
• ISSN: 1699-3055; 1699-3055
• DOI: 10.1007/s12094-024-03412-9

Purpose Immunotherapy has shown remarkable benefits for non-small cell lung cancer (NSCLC) since approved by the US Food and Drug Administration (FDA). Texas, however, ranks below the national average in access to treatment for NSCLC. This retrospective cohort study assessed first-line immunotherapy treatment patterns and associated factors pre- and post-FDA approval in Texas. Methods Patients ≥18 years diagnosed with NSCLC from the Texas Cancer Registry database (2011–2018) and were stratified into pre- and post-FDA approval era. The rates of immunotherapy utilization were examined, and the average annual percent change (AAPC) in immunotherapy utilization across patient subgroups was compared. Multivariable logistic regression was used to identify associations of patient characteristics with immunotherapy utilization for patients with metastatic- and all-stage NSCLC. Results A total of 13,501 and 9509 patients with NSCLC were identified in pre–post-approval periods, respectively. Post-approval, immunotherapy utilization increased from 1.7 to 13.0%, and AAPC from 54.8 to 82.7%. Pre-approval, patients living in a county with ≥20% of households below the poverty level were less likely to receive immunotherapy (OR = 0.73, 95% CI = 0.61–0.94) while patients with private insurance were more likely to receive immunotherapy (OR = 1.56, 95% CI = 1.10–2.23). Post-approval, socioeconomic disparities were more prominent (10–19.9 and ≥20% of households below the poverty level: OR = 0.77, 95% CI = 0.66–0.90 and OR = 0.71, 95% CI = 0.60–0.86, respectively). Patients with metastatic NSCLC showed similar patterns of socioeconomic disparities pre- and post-approval. Conclusions Our findings suggest that patients’ socioeconomic status hinders immunotherapy utilization for NSCLC in Texas. This emphasizes the need for state health policy reforms such as Medicaid expansion and tailored cancer care strategies.