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Rapid Diversification of Immune Checkpoint Inhibitor Usage in Community Health Systems in the US Following New Drug Approvals

Speaker(s)

Winzeler A, Kane K, Zhang C, Subramanian A, Rioth M, Berry A, Brown T
Syapse, San Francisco, CA, USA

OBJECTIVES: Community health systems (CHS) provide >50% of cancer care in the US. This analysis describes how the relative utilization of specific immune checkpoint inhibitors (ICIs) within CHS changed over time with new drug approvals.

METHODS: A retrospective analysis was performed utilizing Syapse’s Learning Health NetworkTM, an electronic medical record derived database comprising cancer care data from multiple care settings within CHS across 33 states, 450+ hospitals and 1,900+ oncologists. Patients included: those >18 yo; stage IIIB, IIIC, or IV non-small cell lung cancer OR early stage diagnosis with recurrence/progression on or after 1/1/2015; >1 patient encounter within 90 days of advanced diagnosis; received an ICI (nivolumab, pembrolizumab, or atezolizumab) before 7/1/2017; and data were reviewed by Syapse Certified Tumor Registrars. The first ICI received by each patient was assessed over time.

RESULTS: The study included 360 patients. In quarters between 2015 and Q3 2016, >86% of patients received nivolumab as their first ICI. In subsequent quarters, the percentages of nivolumab, pembrolizumab, and atezolizumab, respectively, as the first ICI were: Q3 2016: 89%, 8%, 3%. Q4 2016: 58%, 38%, 5%. Q1 2017: 33%, 61%, 6%. Q2 2017: 27%, 51%, 22%.

CONCLUSIONS: Achieving first to market status within a category of therapies is generally accepted as a driver of market advantage. We observed a rapid diversification of first ICI usage in patient management following new drug approvals. The 1L approval of pembrolizumab in October 2016 and negative 1L results for nivolumab in August 2016 coincided with this shift. A similar analysis in RWD from independent oncology practices observed slower ICI diversification during the same time frame. These practice patterns demonstrate that CHS are capable of rapidly adopting new therapies, potentially limiting first-mover advantage in CHS.

Code

RWD118

Topic

Study Approaches

Topic Subcategory

Electronic Medical & Health Records

Disease

Drugs