Checkpoint inhibitors are rapidly adopted in clinical practice

  • O'Connor JM & al.
  • JAMA Oncol
  • 1 Aug 2018

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Anti-programmed cell death 1 (PD-1) protein agents were rapidly adopted in clinical practice after the US Food and Drug Administration (FDA) approval.
  • Patients treated in clinical practice were significantly older vs those in pivotal clinical trials.

Why this matters

  • The finding indicates that clinical practice can change promptly and substantially when novel cancer therapies are approved and launched.
  • Gaps in knowledge of clinicians in terms of patient characteristics in clinical trials are concerning; liberal use of approved therapy without assessing patient characteristics can pose health risks.

Study design

  • Study of 15,856 patients who received systemic treatment for stage III-IV melanoma, stage I-II melanoma with locoregional or distant recurrence, stage IV NSCLC, stage IV RCC, or stage I-III RCC with metastatic progression between 2011 and 2016.
  • Funding: National Center for Advancing Translational Science, a component of the National Institutes of Health.

Key results

  • 3089 patients were eligible for anti-PD-1 treatment.
  • Overall 68.7% of eligible patients received anti-PD-1 treatment (melanoma, 79.1%; NSCLC, 65.6%; RCC, 71.2%).
  • At least 60% of eligible patients in each cancer group received anti-PD-1 treatment within 4 months after FDA approval.
  • No difference was observed in proportions of older and younger patients who received anti-PD-1 treatment within 9 months after approval.
  • 60.6%-63.9% of patients across all cancer groups were aged >65 years in clinical practice vs 31.7%-41.0% in pivotal clinical trials (all P<.001>

Limitations

  • Mostly community-based practices, findings may not generalize to more advanced treatment centers.