Association of Sociodemographic Factors With Immunotherapy Receipt for Metastatic Melanoma in the US

Moyers, Justin T.; Patel, Amie; Shih, Wendy; Nagaraj, Gayathri

doi:10.1001/jamanetworkopen.2020.15656

Cited by 35 publications

(46 citation statements)

References 37 publications

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“…We and others have previously analyzed ICI use patterns for patients with advanced melanoma primarily in the ipilimumab era, when anti–PD-1 use was likely restricted to clinical trial or off-label use. 2 , 12 , 29 , 30 , 31 Herein we found that first-line ICI use has increased to 63% of newly diagnosed patients with stage IV melanoma in 2019, from 9% in 2010 and 39% in 2015 (the year leading up to FDA approval of first-line anti–PD-1). In order to investigate the patient, socioeconomic, and care setting factors associated with underutilization of first-line ICI, we also incorporated landmark time points into our analysis to help account for the immortal time bias associated with receipt of ICI, in which early mortality would preclude patients who would otherwise receive first-line ICI from doing so.…”

Section: Discussionmentioning

confidence: 90%

Use of First-Line Immune Checkpoint Inhibitors and Association With Overall Survival Among Patients With Metastatic Melanoma in the Anti–PD-1 Era

Lamba¹,

Ott

Iorgulescu

2022

JAMA Netw Open

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Key Points Question Following the US Food and Drug Administration’s approval of PD-1 immune checkpoint inhibitors (ICI) for metastatic melanoma, what were the utilization and overall survival associated with ICI in the first-line setting after 2015? Findings In this cohort study of 16 831 patients with metastatic melanoma, first-line immunotherapy use increased from 2010 to 2019, although 38% of patients still were not receiving first-line ICI in 2019. Use of ICI was associated with improvements in survival, even among those with brain metastases. Meaning First-line ICI therapy was associated with substantial improvements in overall survival among patients with metastatic melanoma, but rates of use remain suboptimal.

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Section: Discussionmentioning

confidence: 90%

Use of First-Line Immune Checkpoint Inhibitors and Association With Overall Survival Among Patients With Metastatic Melanoma in the Anti–PD-1 Era

Lamba¹,

Ott

Iorgulescu

2022

JAMA Netw Open

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“…89 In the case of immunotherapy, there is accumulating evidence documenting barriers in access to immunotherapy from large population-or hospital-based data, cancer registries, and meta-analyses. [55][56][57][90][91][92][93] This constellation of factors can be summarized as patient-, provider-, health care system-, and societal/policy-level factors.…”

Section: Barriers To Equal Access To Immunotherapymentioning

confidence: 99%

Immune-Based Cancer Treatment: Addressing Disparities in Access and Outcomes

Osarogiagbon¹,

Sineshaw

Unger

et al. 2021

American Society of Clinical Oncology Educational Book

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Avoidable differences in the care and outcomes of patients with cancer (i.e., cancer care disparities) emerge or worsen with discoveries of new, more effective approaches to cancer diagnosis and treatment. The rapidly expanding use of immunotherapy for many different cancers across the spectrum from late to early stages has, predictably, been followed by emerging evidence of disparities in access to these highly effective but expensive treatments. The danger that these new treatments will further widen preexisting cancer care and outcome disparities requires urgent corrective intervention. Using a multilevel etiologic framework that categorizes the targets of intervention at the individual, provider, health care system, and social policy levels, we discuss options for a comprehensive approach to prevent and, where necessary, eliminate disparities in access to the clinical trials that are defining the optimal use of immunotherapy for cancer, as well as its safe use in routine care among appropriately diverse populations. We make the case that, contrary to the traditional focus on the individual level in descriptive reports of health care disparities, there is sequentially greater leverage at the provider, health care system, and social policy levels to overcome the challenge of cancer care and outcomes disparities, including access to immunotherapy. We also cite examples of effective government-sponsored and policy-level interventions, such as the National Cancer Institute Minority-Underserved Community Oncology Research Program and the Affordable Care Act, that have expanded clinical trial access and access to high-quality cancer care in general.

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“…Insurance-associated differences in immunotherapy use have been previously described, albeit not specifically with regard to the preapproval era. 13 , 25 , 36 , 37 Lower income has been associated with lower use of immunotherapy for melanoma 27 , 38 but not for RCC and NSCLC. One possible explanation could be travel burden because, particularly among patients with RCC and melanoma, fewer than one-half of the hospitals that treated patients for the 3 cancer types included in this study were administering immunotherapy before FDA approval.…”

Section: Discussionmentioning

confidence: 99%

Association Between Food and Drug Administration Approval and Disparities in Immunotherapy Use Among Patients With Cancer in the US

et al. 2022

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IMPORTANCE Clinical trials and compassionate use agreements provide selected patients with access to potentially life-saving treatments before approval by the Food and Drug Administration (FDA). Approval from the FDA decreases a number of access barriers; however, it is unknown whether FDA approval is associated with increases in the equitable use of novel therapies and reductions in disparities in use among patients with cancer in the US. OBJECTIVETo assess the association between FDA drug approval and disparities in the use of immunotherapy across health, sociodemographic, and socioeconomic strata before and after approval of the first checkpoint inhibitors for the treatment of patients with cancer in the US. DESIGN, SETTING, AND PARTICIPANTSThis cohort study used data from the National Cancer Database to examine the use of immunotherapy across health, sociodemographic, and socioeconomic strata before and after FDA approval of the first checkpoint inhibitor therapies. A total of 402 689 patients 20 years or older who were diagnosed with stage IV non-small cell lung cancer (NSCLC), renal cell carcinoma (RCC), or melanoma of the skin between January 1, 2007, and December 31, 2018 (specific years varied by tumor type), were included. EXPOSURES Patient health (Charlson-Deyo comorbidity score and age), sociodemographic characteristics (sex, race, and ethnicity), and socioeconomic (insurance status and household income based on zip code of residence) characteristics. MAIN OUTCOMES AND MEASURESThe association of patient characteristics with receipt of immunotherapy was evaluated in the 4 years before and the 3 years immediately after FDA approval using multivariable logistic regression modeling. RESULTSAmong 402 689 patients (median [IQR] age, 68 [60-76 years]; 225 081 men [55.9%]), 347 233 had NSCLC, 43 714 had RCC, and 11 742 patients had melanoma. A total of 47 527 patients (11.8%) were Black, 15 763 (3.9%) were Hispanic, 375 874 (93.3%) were non-Hispanic, 335 833 (83.4%) were White, and 16 553 (4.1%) were of other races. Before FDA approval, 6271 patients (3.2%) with NSCLC, 1155 patients (4.8%) with RCC, and 504 patients (8.6%) with melanoma received immunotherapy compared with 23 908 patients (15.6%) with NSCLC, 3890 patients (19.7%) with RCC, and 1143 patients (19.3%) with melanoma after FDA approval. Before FDA approval, sociodemographic and socioeconomic characteristics were associated with variable immunotherapy administration by tumor type. For example, among those with NSCLC, Black patients were less likely to receive immunotherapy than White patients (odds ratio [OR], 0.78; 95% CI ,0.71-0.85; P < .001); among those with RCC, uninsured patients were less likely to receive immunotherapy than privately insured patients (OR, 0.31; 95% CI, 0.20-0.48; P < .001). After FDA approval, most disparities persisted, but several narrowed (eg, Black patients with NSCLC: OR, 0.87 [95% CI, 0.83-0.91; (continued) Key Points Question Is drug approval by the Food and Drug Administration (FDA) associated with a reduction in di...

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Association of Sociodemographic Factors With Immunotherapy Receipt for Metastatic Melanoma in the US

Cited by 35 publications

References 37 publications

Use of First-Line Immune Checkpoint Inhibitors and Association With Overall Survival Among Patients With Metastatic Melanoma in the Anti–PD-1 Era

Use of First-Line Immune Checkpoint Inhibitors and Association With Overall Survival Among Patients With Metastatic Melanoma in the Anti–PD-1 Era

Immune-Based Cancer Treatment: Addressing Disparities in Access and Outcomes

Association Between Food and Drug Administration Approval and Disparities in Immunotherapy Use Among Patients With Cancer in the US

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