Chi-Chang Chen

Purpose: Clinical guidelines recommend next-generation sequencing (NGS) before initiation of first-line (1L) therapy as the standard of care for patients with advanced non–small cell lung cancer (aNSCLC). This study examined the impact of timing of molecular testing in relation to treatment initiation on overall survival (OS) to help inform clinical decision making for aNSCLC treatment. Methods: This retrospective cohort study analyzed the Flatiron Health aNSCLC deidentified database from 2019 to 2021. Patients with aNSCLC and 1L systemic therapy were grouped into three cohorts based on timing of testing: (1) up-front NGS; (2) up-front non-NGS genomic testing; and (3) NGS after 1L therapy initiation. Kaplan-Meier analysis and Cox Proportional Hazards models were used to compare OS from the date of aNSCLC diagnosis between cohorts. Results: Overall, 13,139 patients with aNSCLC treated with systemic therapy were identified, including 6,210 patients with up-front tumor NGS, 2,697 patients with up-front non-NGS testing, and 2,824 patients with NGS after 1L initiation. A higher proportion of patients with up-front NGS received targeted therapy compared with patients with NGS after 1L initiation (22.6% v 14.8%, P < .0001). Median OS was significantly longer (20.9 months) with up-front NGS compared with up-front non-NGS (17.5 months) and NGS testing after 1L (18.2 months, P < .005). Multivariable analyses suggest that OS benefits associated with up-front NGS were primarily attributable to treatment. Conclusion: NGS testing before 1L therapy was observed to be associated with earlier use of targeted therapy and longer survival when compared with other testing strategies. Future studies are warranted given the rapidly evolving treatment landscape in aNSCLC.

Background: Metastatic castration-resistant prostate cancer (mCRPC) treatment commonly includes first-line (1L) androgen receptor pathway inhibitors (ARPIs) followed by second-line (2L) taxane-based chemotherapy. Adverse events (AEs) may lead to early taxane discontinuation, which can negatively affect outcomes and costs. This retrospective observational study assessed real-world outcomes, AEs, and costs of 2L taxane therapy by number of cycles among patients with mCRPC previously treated with a 1L ARPI; outcomes were compared with patients receiving 2L ARPI. Methods: Overall survival (OS; overall and by number of taxane cycles received) was determined for 2L taxane and compared with 2L ARPI using the Flatiron Health electronic health record database (Jul 1, 2012, to Jun 30, 2020). Taxane-related AEs and associated costs were estimated using the IQVIA PharMetrics® Plus claims database (Jan 1, 2013, to Aug 31, 2021). Results: Overall, 2L ARPI ( n = 473) vs. taxane ( n = 214) was associated with longer median OS (15.4 vs. 13.6 months). Patients receiving > 8 ( n = 48) vs. ≤ 8 taxane cycles ( n = 166) had longer median OS (18.4 vs. 11.9 months; p = 0.006). Patients receiving > 8 vs. ≤ 8 taxane cycles were also more likely to experience an AE (95% vs. 88%) but had lower mean AE-related total healthcare costs per patient per month ($3,429 vs. $6,334). Conclusion: Patients who received > 8 cycles of 2L taxane had longer observed survival. However, these results are subject to selection bias and immortal time bias. Prospective or time-adjusted analyses are needed.

Several vaccines are recommended for 16-23-year-olds in the United States, but coverage varies widely across these vaccines. Previous studies have indicated that routine healthcare visits are associated with vaccination uptake. This study aimed to describe healthcare visit patterns among 16-23-year-olds to identify challenges and inform opportunities to reach adolescents and young adults for vaccination. A descriptive, retrospective database analysis was conducted of commercially insured and Medicaid-insured 16-23-year-olds from 2019-2022 using IQVIA's PharMetrics® Plus claims database and open-source Longitudinal Prescription/Medical claims databases. The proportion of 16-23-year-olds with healthcare provider (HCP) visits, visit types, provider types involved, visits including vaccination, and specific vaccines delivered were analyzed. In 2022, 68.2% of commercially insured 16-23-year-olds had ≥1 HCP visit. Most commercially insured and Medicaid-insured individuals with ≥1 HCP visit had sick visits (72.9-80.6%). The proportion of individuals with preventative visits was lower as age increased (commercially insured: 73.2% at 16, 67.4% at 18, 56.3% at 19, and 45.3% at 23 years). Lower proportions of individuals with preventative visits with increasing age were also seen among Medicaid-insured individuals, ranging from 53.7% at 16 years to 28.0% at 23 years. Among 16-18-year-olds with ≥1 HCP or pharmacy visit in 2022, 52.6% in the commercial cohort and 33.0% in the Medicaid cohort had visits that involved vaccination; for 19-23-year-olds, these proportions were 34.5% and 25.6%, respectively. Vaccination rates by vaccine type were largely aligned with the ages specified by recommendations, but nonetheless were low. Approximately one-third of commercially insured 16-23-year-olds did not have an annual HCP visit, and among commercially insured and Medicaid-insured individuals who did have visits, a substantial proportion did not have preventative visits; this proportion was higher with increasing age. The proportions of visits with vaccination were particularly low for 19-23-year-olds. Targeted interventions to promote routine visits, including framing these as opportunities for immunization, may help to increase vaccination uptake; based on the findings of this analysis, these efforts should consider age-specific shifts in health-seeking behaviors.

In the United States (US), meningococcal serogroup B (MenB) vaccination is currently recommended under shared clinical decision-making for 16-23-year-olds to prevent invasive meningococcal disease; the MenB vaccine may be co-administered with other vaccines recommended for this age group. A retrospective analysis of two US health insurance claims databases was conducted to estimate the proportion of commercially insured and Medicaid-insured 16-23-year-olds with potential missed opportunities for MenB vaccine series initiation via co-administration. Potential missed opportunities were defined as visits with healthcare providers during which other recommended vaccines (MenACWY, Tdap, HPV, influenza, and/or COVID-19) were administered, but not the initial MenB vaccine dose. In 2022, 74.5% of commercially insured and 67.1% of Medicaid-insured 16-23-year-olds had potential missed opportunities for MenB vaccination initiation via co-administration. The proportion of missed opportunities was higher among 19-23-year-olds (versus 16-18-year-olds) and lower for visits with pediatricians (versus internists or general practitioners/family physicians). The most frequently co-administered vaccine was the MenACWY vaccine. Many 16-23-year-olds had potential missed opportunities for MenB series initiation via co-administration. Increasing awareness of the opportunity to initiate the MenB series via co-administration may improve meningococcal vaccination coverage in the United States.

Evaluate multiple myeloma (MM) treatment patterns, healthcare utilization (HCRU), and costs from academic and community settings. This observational study linked US MM insurance claims (1 April 2017-30 June 2022) with provider affiliations to evaluate patient characteristics and treatment durations across patient cohorts defined by care setting of treatment (academic only, community only, mixed [both]), as well as treatment patterns, HCRU, and costs of care (e.g. treatment, office visits, hospitalization) in each setting. 3778 patients were included. By cohort (n = 530 academic; n = 1647 community), the community cohort was older with more comorbidities. Mixed-cohort patients (n = 1601) frequently initiated treatment at community centers and briefly shifted to academic centers for transplant. Among 3778 patients who received MM-related care, most claims were from the community setting. The academic setting had high rates of claims for proteasome inhibitors (56.3% of patients) and steroids (52.5%); the community setting had high rates for immunomodulatory drugs (75.1%) and steroids (85.0%). Stem cell transplant claims were more common for academic versus community (21.4%/7.3%). Treatment duration/time to next therapy were similar between cohorts. Costs were generally higher in the academic versus community settings. Improved patient support is needed in community settings, where most MM care occurs.

Evaluate treatment and outcomes by social determinants of health (SDoH) in multiple myeloma (MM), which are important for improving care and outcomes. This was a retrospective study of real-world patients enrolled in a US insurance claims database (MM diagnosis, July 2018-December 2022) with linkage to a SDoH database, supplemented with mortality, provider affiliation (academic/community), and socioeconomically disadvantaged area databases. Treatment and outcomes were evaluated across SDoH domains: race/ethnicity, education level, transportation access, food insecurity, risky health behaviors, living in disadvantaged areas, healthcare needs, and ease of healthcare-systems engagement. The study included 4768 patients (2295 and 2731 with care-setting and treatment data); median follow-up, 584 days. Patients treated in academic versus community settings were less likely to be food insecure and live in disadvantaged areas and had lower healthcare needs. Stem cell transplant was more common in White versus non-White patients, those with low versus high food insecurity and healthcare needs, and high versus low ease of healthcare-systems engagement. In multivariable analysis, high versus low disadvantaged areas (HR = 1.75) and medium versus low food insecurity (HR = 1.80) were associated with shorter overall survival. These findings indicate a need for improved access to care in the broader MM population.

Meningococcal serogroup B (MenB) vaccination is recommended by the Advisory Committee on Immunization Practices (ACIP) for adolescents and young adults 16-23-years-old under shared clinical decision-making (SCDM). However, MenB vaccination coverage in this population remains low in the United States (US). We investigated the awareness, attitudes, and practices regarding MenB disease and vaccination among parents of 16-18-year-old older adolescents and among 19-23-year-old young adults. An online survey was conducted in September-October 2022 among parents of older adolescents and among young adults recruited from a US-based patient panel. There were 606 total participants, including parents of MenB-vaccinated (n = 151) and non-vaccinated (n = 154) adolescents, and also MenB-vaccinated (n = 150) and non-vaccinated (n = 151) young adults. Non-vaccinated cohorts reported low awareness of MenB disease (58.3-67.5%) and vaccination (49.7-61.0%), though awareness was higher among non-vaccinated parents. However, all cohorts reported high interest in learning more about MenB disease and vaccination. Vaccinated cohorts relied on primary care providers (PCPs) to initiate MenB vaccination conversation and had a low awareness of SCDM at 35.1-45.3%, though those aware of SCDM were more likely to participate in decision-making. Barriers to MenB vaccination included lack of PCP recommendation, vaccine side effects, and uncertainty about vaccination need. There are gaps in awareness of MenB disease, vaccination, and SCDM among parents and patients in the US, resulting in missed opportunities for discussing and administering MenB vaccination. Targeted education on MenB and vaccination recommendations may increase these opportunities and improve MenB vaccination awareness and initiation.

Real-world (RW) evidence is needed to evaluate atezolizumab plus bevacizumab (atezo + bev) utilization for hepatocellular carcinoma (HCC) in clinical practice. This retrospective cohort study used administrative claims databases to evaluate treatment patterns in individuals with HCC ≥18 years of age who were initiated on atezo + bev between June 2020 and June 2022. The endpoints of this study were the proportion of individuals who discontinued atezo + bev and received subsequent systemic therapies, time to discontinuation (TTD), and time to next treatment. Overall, 825 individuals were eligible (median age 67 years; 80% male). Over a median follow-up of 15.3 months, most (72%) discontinued atezo + bev, with a median TTD of 3.5 months. A minority (19%) received subsequent therapies, with the most common second-line agents being lenvatinib (6%), cabozantinib (4%), and nivolumab (4%). The median time from index to next treatment post-atezo + bev was 5.4 months. Further research is needed to identify the patients who are most likely to benefit from atezo + bev as well as later-line HCC therapies to optimize overall survival.