PMID- 36809528 OWN - NLM STAT- MEDLINE DCOM- 20230224 LR - 20230324 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 18 IP - 2 DP - 2023 TI - Health outcomes and healthcare resource utilization among Veterans with stage IV non-small cell lung cancer treated with second-line chemotherapy versus immunotherapy. PG - e0282020 LID - 10.1371/journal.pone.0282020 [doi] LID - e0282020 AB - BACKGROUND: Until recently, multi-agent chemotherapy (CT) was the standard of care for patients with advanced non-small cell lung cancer (NSCLC). Clinical trials have confirmed benefits in overall survival (OS) and progression-free survival with immunotherapy (IO) compared to CT. This study compares real-world treatment patterns and outcomes between CT and IO administrations in second-line (2L) settings for patients with stage IV NSCLC. MATERIALS AND METHODS: This retrospective study included patients in the United States Department of Veterans Affairs healthcare system diagnosed with stage IV NSCLC during 2012-2017 and receiving IO or CT in the 2L. Patient demographics and clinical characteristics, healthcare resource utilization (HCRU), and adverse events (AEs) were compared between treatment groups. Logistic regression was used to examine differences in baseline characteristics between groups, and inverse probability weighting multivariable Cox proportional hazard regression was used to analyze OS. RESULTS: Among 4,609 Veterans who received first-line (1L) therapy for stage IV NSCLC, 96% received 1L CT alone. A total of 1,630 (35%) were administered 2L systemic therapy, with 695 (43%) receiving IO and 935 (57%) receiving CT. Median age was 67 years (IO group) and 65 years (CT group); most patients were male (97%) and white (76-77%). Patients administered 2L IO had a higher Charlson Comorbidity Index than those administered CT (p = 0.0002). 2L IO was associated with significantly longer OS compared with CT (hazard ratio 0.84, 95% CI 0.75-0.94). IO was more frequently prescribed during the study period (p < 0.0001). No difference in rate of hospitalizations was observed between the two groups. CONCLUSIONS: Overall, the proportion of advanced NSCLC patients receiving 2L systemic therapy is low. Among patients treated with 1L CT and without IO contraindications, 2L IO should be considered, as this supports potential benefit of IO for advanced NSCLC. The increasing availability and indications for IO will likely increase the administration of 2L therapy to NSCLC patients. CI - Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. FAU - Williams, Christina D AU - Williams CD AUID- ORCID: 0000-0002-6925-3482 AD - Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, North Carolina, United States of America. AD - Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina, United States of America. FAU - Allo, Mina A AU - Allo MA AD - Bristol-Myers Squibb Company, US Health Economics and Outcomes Research, Princeton, New Jersey, United States of America. FAU - Gu, Lin AU - Gu L AD - Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, North Carolina, United States of America. AD - Duke Cancer Institute, Biostatistics Shared Resource, Duke University, Durham, North Carolina, United States of America. FAU - Vashistha, Vishal AU - Vashistha V AUID- ORCID: 0000-0003-4359-6636 AD - Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina, United States of America. AD - Division of Hematology-Oncology, Medical Service, Durham Veterans Affairs Health Care System, Durham, North Carolina, United States of America. FAU - Press, Ashlyn AU - Press A AD - Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, North Carolina, United States of America. FAU - Kelley, Michael AU - Kelley M AD - Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina, United States of America. AD - Division of Hematology-Oncology, Medical Service, Durham Veterans Affairs Health Care System, Durham, North Carolina, United States of America. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230221 PL - United States TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - United States MH - Humans MH - Male MH - Aged MH - Female MH - *Carcinoma, Non-Small-Cell Lung/drug therapy MH - *Lung Neoplasms/drug therapy MH - Retrospective Studies MH - *Veterans MH - Patient Acceptance of Health Care MH - Immunotherapy MH - Outcome Assessment, Health Care PMC - PMC9942992 COIS- This study was supported by Bristol-Myers Squibb Company (BMS). Dr. Allo was affiliated with BMS. BMS did not have access to underlying data and did not contribute to any data analysis. This commercial affiliation does not alter the adherence to PLOS ONE policies on sharing data and materials. The authors declare no other competing interests. EDAT- 2023/02/23 06:00 MHDA- 2023/02/25 06:00 PMCR- 2023/02/21 CRDT- 2023/02/22 13:52 PHST- 2022/03/07 00:00 [received] PHST- 2023/02/06 00:00 [accepted] PHST- 2023/02/22 13:52 [entrez] PHST- 2023/02/23 06:00 [pubmed] PHST- 2023/02/25 06:00 [medline] PHST- 2023/02/21 00:00 [pmc-release] AID - PONE-D-22-02351 [pii] AID - 10.1371/journal.pone.0282020 [doi] PST - epublish SO - PLoS One. 2023 Feb 21;18(2):e0282020. doi: 10.1371/journal.pone.0282020. eCollection 2023.