Real-World Treatment Patterns Among Patients Initiating Small Molecule Kinase Inhibitor Therapies for Thyroid Cancer in the United States

Abstract

IntroductionLittle is known about real-world use of small molecule kinase inhibitors (SMKI) for advanced thyroid cancer in the United States. This study examined prescribing patterns of SMKI agents recommended by the National Comprehensive Cancer Center (NCCN).MethodsThis retrospective study used a national health insurance database to identify patients diagnosed with thyroid cancer during 1/1/2006–6/30/2016 and with prescription claims for NCCN-recommended SMKI during 1/1/2010–5/31/2016 whose first claim date was the index date. Inclusion also required continuous enrollment in a health plan for 3 months pre-index (baseline) and ≥ 1 month post-index (follow-up) with no claims for SMKI during baseline. Lines of therapy (LOT) were defined by the date of SMKI claims and days of drug supply. Median time to SMKI discontinuation in each LOT was estimated by Kaplan–Meier method.ResultsThe study included 217 patients. During follow-up (mean duration 499.0 days), 35.5% of patients (n = 77) received a second or later LOT; among patients with ≥ 12 months follow-up after first LOT (LOT1) initiation, 53.1% (n = 60) received a second or later LOT. Median treatment duration was 5.0 months for LOT1 and 5.1 months for LOT2. Over the entire follow-up period (2010–2016), sorafenib was the most common regimen in LOT1 (36.9% of patients) and LOT2 (24.7%) followed by sunitinib and levantinib (13.4% each) in LOT1 and sunitinib (19.5%) in LOT2. Starting in 2015, the year lenvatinib was approved for differentiated thyroid cancer, lenvatinib was the most common first-line regimen among patients initiating LOT1 in 2015 (43.4%) and 2016 (66.7%).ConclusionSorafenib was the most common first-line agent during 2010–2014 but was supplanted by lenvatinib starting in 2015. Approximately 36–53% of patients received a second-line treatment. Median treatment duration results suggested potential benefit of SMKI in second-line therapy. SMKI treatment after first-line failure may be considered for appropriately selected patients.FundingEisai, Inc. (Woodcliff Lake, NJ).

Impact of baseline tumor burden on overall survival in patients with radioiodine‐refractory differentiated thyroid cancer treated with lenvatinib in the SELECT global phase 3 trial

“…RAI‐R DTC is an aggressive and often rapidly progressing disease, 1,2,5 and only approximately 36% to 53% of patients with RAI‐R DTC receive a second‐line therapy 18 . Thus, timely and precise treatment selection is crucial to maximize efficacy outcomes.…”

Lenvatinib and Subsequent Therapy for Radioactive Iodine-Refractory Differentiated Thyroid Cancer: A Real-World Study of Clinical Effectiveness in the United States

“…This is the first and largest real-world study in the USA to evaluate outcomes of 1L lenvatinib therapy and post-lenvatinib therapy for patients with RAI-r DTC. After approval in 2015, lenvatinib replaced sorafenib as the most commonly prescribed 1L treatment for DTC, representing 43.4% and 66.7% of 1L treatment in 2015 and 2016, respectively [ 14 ]. These real-world data provide supporting evidence that when prescribed in the community setting, up to 64.8% of patients treated with lenvatinib in 1L experienced disease response (similar to that observed in the pivotal SELECT trial) [ 13 ].…”

“…A recent administrative claims study from the USA demonstrated that lenvatinib is the most commonly prescribed first-line (1L) agent for the treatment of RAI-r DTC [ 14 ]. However, no real-world clinical outcomes for patients who receive 1L lenvatinib in the USA have been reported previously.…”

The Role of the Kinase Inhibitors in Thyroid Cancers

“…The efficacy of Lenvatinib has been also corroborated by quality-of-life (QOL) studies demonstrating the efficacy of this treatment [ 30 ], positioning it as first-line treatment [ 31 ].…”