TY - JOUR
T1 - Real-world effectiveness of systemic agents approved for advanced non-small cell lung cancer
T2 - A SEER-medicare analysis
AU - Owonikoko, Taofeek K.
AU - Ragin, Camille
AU - Chen, Zhengjia
AU - Kim, Sungjin
AU - Behera, Madhusmita
AU - Brandes, Johann C.
AU - Saba, Nabil F.
AU - Pentz, Rebecca
AU - Ramalingam, Suresh S.
AU - Khuri, Fadlo R.
N1 - Owonikoko, Taofeek K Ragin, Camille Chen, Zhengjia Kim, Sungjin Behera, Madhusmita Brandes, Johann C Saba, Nabil F Pentz, Rebecca Ramalingam, Suresh S Khuri, Fadlo R 1K23CA164015/CA/NCI NIH HHS/United States K23 CA164015/CA/NCI NIH HHS/United States P01CA116676/CA/NCI NIH HHS/United States P01CA116676-5S1/CA/NCI NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States The oncologist Oncologist. 2013;18(5):600-10. doi: 10.1634/theoncologist.2012-0480. Epub 2013 May 1.
PY - 2013/5
Y1 - 2013/5
N2 - Objectives. Disparity exists between patients with lung cancer enrolled in clinical trials and patients treated in the community setting. This study assessed the real-world effectiveness of cytotoxic agents that became available for the treatment of non-small cell lung cancer (NSCLC) in the last 2 decades. Methods. We employed the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database for patients diagnosed with stage IIIB/IV NSCLC between 1988 and 2005 to assess the effectiveness of newly approved agents. Effectiveness of specific agents was assessed at time periods immediately following the approval of the agent for NSCLC: baseline, 1988-1994; platinum, 1995-1999; docetaxel, 1999-2003; pemetrexed and bevacizumab, 2004-2005. Significant associations between specific drug treatment and survival improvement were determined using theKaplan-Meier method, Cox proportional hazard model, and propensity score analyses. Significant differences were established by log-rank test. Results. This analysis employed data from 143,548 patients by sex (58% male, 42% female), cancer stage (35% stage IIIB, 65% stage IV), and age (12% 20-64 years, 22% 65-69 years, 45% 70-79 years, 22% 80 years and older). There was temporal improvement in survival for patients treated with newly approved chemotherapy (1-year survival rates: 32.41% in 19881994, 32.95% in 1995-1998, 37.40% in 1999-2003, and 39.55% in 2004-2005). Patients treated with a newly approved drug during the relevant treatment era had a significant reduction in the risk of death when compared with patients treated with chemotherapy other than the newly approved agent (hazard ratios [95% confidence interval] were 0.76 [0.71-0.81] forplatinum,0.73 [0.70-0.75]for docetaxel, 0.40 [0.37-0.44]for pemetrexed, and 0.33 [0.27-0.40] for bevacizumab; p <. 001). Propensity score adjustment did not significantly alter these results. Conclusions. Currently approved drugs for the treatment of advanced NSCLC are associated with improved survival in the U.S. Medicare patient population. Our findings support the effectiveness of these agents in the real-world oncology practice.
AB - Objectives. Disparity exists between patients with lung cancer enrolled in clinical trials and patients treated in the community setting. This study assessed the real-world effectiveness of cytotoxic agents that became available for the treatment of non-small cell lung cancer (NSCLC) in the last 2 decades. Methods. We employed the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database for patients diagnosed with stage IIIB/IV NSCLC between 1988 and 2005 to assess the effectiveness of newly approved agents. Effectiveness of specific agents was assessed at time periods immediately following the approval of the agent for NSCLC: baseline, 1988-1994; platinum, 1995-1999; docetaxel, 1999-2003; pemetrexed and bevacizumab, 2004-2005. Significant associations between specific drug treatment and survival improvement were determined using theKaplan-Meier method, Cox proportional hazard model, and propensity score analyses. Significant differences were established by log-rank test. Results. This analysis employed data from 143,548 patients by sex (58% male, 42% female), cancer stage (35% stage IIIB, 65% stage IV), and age (12% 20-64 years, 22% 65-69 years, 45% 70-79 years, 22% 80 years and older). There was temporal improvement in survival for patients treated with newly approved chemotherapy (1-year survival rates: 32.41% in 19881994, 32.95% in 1995-1998, 37.40% in 1999-2003, and 39.55% in 2004-2005). Patients treated with a newly approved drug during the relevant treatment era had a significant reduction in the risk of death when compared with patients treated with chemotherapy other than the newly approved agent (hazard ratios [95% confidence interval] were 0.76 [0.71-0.81] forplatinum,0.73 [0.70-0.75]for docetaxel, 0.40 [0.37-0.44]for pemetrexed, and 0.33 [0.27-0.40] for bevacizumab; p <. 001). Propensity score adjustment did not significantly alter these results. Conclusions. Currently approved drugs for the treatment of advanced NSCLC are associated with improved survival in the U.S. Medicare patient population. Our findings support the effectiveness of these agents in the real-world oncology practice.
KW - Aged, 80 and over
KW - Antineoplastic Combined Chemotherapy Protocols/administration & dosage
KW - Carcinoma, Non-Small-Cell Lung/drug therapy
KW - Female
KW - Humans
KW - Lung Neoplasms/drug therapy
KW - Male
KW - Medicare
KW - Meta-Analysis as Topic
KW - Neoplasm Staging
KW - Proportional Hazards Models
KW - SEER Program
KW - Survival Analysis
KW - Treatment Outcome
KW - United States
UR - http://www.scopus.com/inward/record.url?scp=84878170334&partnerID=8YFLogxK
U2 - 10.1634/theoncologist.2012-0480
DO - 10.1634/theoncologist.2012-0480
M3 - Article
C2 - 23635558
SN - 1083-7159
VL - 18
SP - 600
EP - 610
JO - Oncologist
JF - Oncologist
IS - 5
ER -
