Treatment Patterns, Healthcare Resource Use, and Costs Among US Patients With Epidermal Growth Factor Receptor Mutated (EGFRm) Metastatic Non-Small Cell Lung Cancer (mNSCLC) After Discontinuation of Osimertinib

OBJECTIVES: Osimertinib is an established first-line treatment for patients with mNSCLC harboring a common EGFR mutation. Upon EGFR tyrosine kinase inhibitor (TKI) resistance, there is little data to support the standard of care in subsequent lines of therapy (LOT). This study characterized treatment patterns, healthcare resource use and costs in the LOT following osimertinib.

METHODS: This retrospective analysis included administrative claims from commercial, Medicare Advantage and Medicare Fee-for-Service (FFS) health plans. Patients ≥18 years, with diagnosis codes for lung cancer and a secondary malignancy between 7/2018 and 6/2021 (FFS) or 6/2022 (commercial and Medicare Advantage) and received a subsequent (index) LOT after osimertinib discontinuation were included. Kaplan-Meier analyses were used to assess time to treatment discontinuation (TTD).

RESULTS: 1,006 patients (median age: 71 years; 66% female; 62% FFS) met eligibility. 92.6% had 1 regimen prior to index LOT. During the index LOT, EGFR TKI combination regimens were most prescribed (25.7%), followed by immunotherapy combinations (24.8%), platinum-based chemotherapy (21.5%), EGFR TKI monotherapy (11.0%), immunotherapy (10.1%), non-platinum chemotherapy (4.1%) and other regimens (2.8%). 49% of EGFR TKI and 93% of immunotherapy combinations included platinum chemotherapy. Median TTD was 4.9 months. Mean (SD) total per-patient per-month (PPPM) healthcare costs ranged from $13,785 ($9,234) for EGFR TKI monotherapy to $25,216 ($9,103) for EGFR TKI combinations. Mean (SD) PPPM medical costs (excluding antineoplastic infusions) were highest for non-platinum chemotherapy [$9,458 ($12,745)], immunotherapy [$7,969 ($8,616)], and platinum chemotherapy [$8,031 ($8,444)]. The proportion of patients with ≥1 inpatient admission was highest for EGFR TKI combinations (31.7%), IO combinations (31.3%), and non-platinum chemotherapy (31.7%).

CONCLUSIONS: Patients with EGFRm mNSCLC received a range of therapies after osimertinib discontinuation suggesting no established standard of care, and duration of treatment was short. There is need for new treatments that support an optimal risk-benefit profile and value for these patients.