A database analysis shows significant shifts in treatment patterns for elderly patients diagnosed with advanced-stage non-small-cell lung cancer (NSCLC), along with a modest gain in survival since 2000.
Over the last two decades, new therapies including targeted agents have emerged for the treatment of advanced NSCLC. “Use, survival, and spending trends of antineoplastic agents provide insight into the value of these therapies and offer a glimpse of the shape of future treatment trends in advanced NSCLC within the context of escalating medical care costs,” wrote study authors led by Cathy J. Bradley, PhD, of the University of Colorado Cancer Center in Aurora.
Investigators used SEER–Medicare data for 22,163 patients aged 65 years or older treated for advanced NSCLC between 2000 and 2011. They analyzed which agents were used, spending on treatment, survival, and other outcomes; the results were published online ahead of print in the Journal of Clinical Oncology.
From 2000 to 2011, the use of several agents declined; these included paclitaxel (58% to 39%), gemcitabine (32% to 17%), and vinorelbine (24% to 6%; P < .001 for all). The use of another set of agents remained approximately the same—these included cisplatin, docetaxel, irinotecan, and etoposide. Carboplatin was used in 67% in 2000 and in 74% in 2011, and was the most commonly prescribed agent in all years.
Pemetrexed, erlotinib, and bevacizumab were not yet available in 2000, but were then rapidly adopted. By 2011, these drugs were used in 39.2%, 20.3%, and 18.9% of patients, respectively (P < .001 for all).
The average number of days of chemotherapy treatment in 2000 was 103, and in 2011 the average of chemotherapy or combination therapy with a targeted agent was 108. Specifically among patients who received pemetrexed, bevacizumab, or erlotinib in 2011, the average duration was 146 days; among those who received none of those the average was only 75 days.
In 2000, 40% of patients received any treatment in the last 30 days of life, and this remained largely unchanged at 43.7% in 2011. The median survival was 7.7 months in 2000, and 9.2 months in 2011 (P < .001). For 2010, there was a hazard ratio for survival relative to 2000 of 0.78 (95% CI, 0.73–0.84).
Over the course of the study period, Medicare and total spending increased modestly; total spending was $80,123 per patient per year in 2000, which rose to $85,087 in 2011. The authors noted that the rise in Medicare spending was lower than expected with the advent of targeted agents, but increases in outpatient spending were offset by a decrease in in-patient costs.
“Taken together, we believe that these findings are an excellent example of the constellation of characteristics that make value-based decisions in healthcare so challenging,” the authors wrote. “More evidence is needed to weigh the benefit of these agents against their costs and the possibility of savings with lower prices and lower in-patient use.”