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Quality Care 2019: Why Do Some Patients With Lung Cancer Delay TKI Treatment?

By: Joseph Fanelli
Posted: Friday, September 13, 2019

For patients with EGFR-positive and ALK-positive advanced non–small cell lung cancer (NSCLC), being male, having Medicare insurance, and receiving chemotherapy prior to tyrosine kinase inhibitor (TKI) treatment are all associated with a delay in TKI initiation, according to findings presented at the 2019 American Society of Clinical Oncology (ASCO) Quality Care Symposium in San Diego (Abstract 134). Bernardo H.L. Goulart, MD, of the Fred Hutchinson Cancer Center, Seattle, and colleagues, hypothesized specific reasons why these factors may delay TKI treatment in this patient population.

“Possible explanations include higher prevalence of smoking in males resulting in lower priority for molecular testing, high cost-sharing policies for TKIs in Medicare patients, and prolonged time to obtain molecular test results leading patients to start chemotherapy first,” the authors concluded.

The authors identified 122 patients who were diagnosed with EGFR-positive and ALK-positive NSCLC between January 2010 and December 2016 in the Washington State Surveillance, Epidemiology, and End Results Program registry. The registry records were linked to commercial and Medicare (including Part D) health insurance claims. Eligible patients had stage IV NSCLC, sensitizing EGFR mutations or ALK-positive by fluorescence in situ hybridization, one or more pharmacy claims for EGFR or ALK TKIs, and at least 12 months of insurance enrollment following diagnosis.

For all patients, the median time to TKI initiation after diagnosis was 6.7 weeks. The authors found that independent predictors of TKI delays included male sex (hazard ratio = 0.53), Medicare insurance (hazard ratio = 0.32), and receiving TKIs before chemotherapy (hazard ratio = 0.37). For male patients versus female patients, the median time to TKI initiation was 9.7 weeks compared with 5.8 weeks, respectively. Patients with Medicare delayed TKI initiation for a median time of 16.0 weeks, compared with a median time of 6.3 weeks for those with commercial insurance.

Disclosure: The study authors’ disclosure information may be found at coi.asco.org.



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