Understanding Reasons For Treatment Disruption of Tyrosine Kinase Inhibitors in NSCLC Patients

Understanding Treatment Patterns, Disruptions & Potential Limitations Of Tyrosine Kinase Inhibitors In ROS1+ Non-Small Cell Lung Cancer Patients In A Retrospective Review Of U.S. Electronic Medical Transcription Records 

This poster was originally presented at ISPOR Europe, November 6-9, 2022, in Vienna, Austria.  

Authors: Andrew Shim, A. Singhania, Dave Iwanyckyj, F. Otalora, B. Morrison, SW Wade 

Affiliations: Turning Point Therapeutics, San Diego, CA, USA; Amplity, Bucks, UK; Wade Outcomes Research and Consulting, Salt Lake City, UT, USA 

Introduction 

This exploratory analysis examined real-world, routine care treatment patterns and potential limitations using US physician narratives of patient encounters. Specific objectives were to describe treatment patterns in patients with ROS1+ non-small cell lung cancer (NSCLC) who received a TKI; potential limitations of TKI including, reasons for treatment disruption; development of treatment resistance, and treatment response 

Methods  

• Data Source: Amplity AnswerY™ (formerly known as Amplity Insights) real-world database (at time of study) evaluated data from January 2015 through November 2021: 

• >50 million electronic medical transcription records of 29 million unique patients from  

• >150,000 multi-specialty providers at approximately 40,000 inpatient/outpatient care sites across 50 states and 2 US territories  

• Study Population: Adult (age >18 years) patients with ROS1+ NSCLC treated with crizotinib, entrectinib, ceritinib, lorlatinib 

Results 

• Total time on first-line primarily TKI ranged from <1 to <18 months. Crizotinib was the most used 1L TKI (i.e., first observed TKI in patient record) with 44% of 1L crizotinib users treated for 6 to <18 months (n=8); 39% for <6 months (n=7) 

• Treatment sequencing indicates that in almost all cases, crizotinib was selected as the 1L TKI (88%) 

• Choice of 2L therapy post TKI was more diverse: 55% of patients were prescribed either crizotinib, ceritinib, or lorlatinib, while other patients used check point inhibitors, chemotherapy, or had an unspecified 2L treatment 

• Over 2/3 of patients (17/25) experienced a TKI treatment disruption, defined as hold, dose reduction, switch, and/or stop. Disruptions occurred for all TKI agents 

• 50% of patients who experienced a TKI disruption had their first disruption within 3 months 

• 65% (15/23) of crizotinib patients experienced at least one disruption. Over ¼ of patients experienced more than one disruption (4) 

• Various symptoms were mentioned on the same records, in close time proximity, as mentions of TKI disruption, along with specific reasons for treatment disruptions, however, these may not necessarily be contributing factors  

Conclusions  

• AnswerY found that crizotinib was the most often used 1L TKI therapy (88% of patients) since it was the only FDA approved ROS1+ TKI until late 2019
• Time on TKI therapy varied considerably, with most patients continuing their 1L TKI for less than 12 months
• Results suggest possible unmet need among ROS1+ NSCLC patients using contemporary TKIs since treatment disruptions are common and often occur soon after initiation
• New therapies that are effective, have lower risk of treatment-resistance, and that offer better tolerability than current TKIs are needed to simplify and improve patient journeys for individuals with ROS1+ NSCLC

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