Health Equity in Patients Receiving Durvalumab for Unresectable Stage III Non-Small Cell Lung Cancer in the US Veterans Health Administration.
Health Equity in Patients Receiving Durvalumab for Unresectable Stage III Non-Small Cell Lung Cancer in the US Veterans Health Administration.
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DOI：
10.1093/oncolo/oyad172
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发表时间：
2023-09-07
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关于种族与durvalumab使用之间的关系，现实世界的证据有限，durvalumab是一种批准用于成人放化疗（CRT）后不可切除的III期非小细胞肺癌（NSCLC）的免疫疗法。本研究旨在评估在退伍军人健康管理局（VHA）人群中，durvalumab治疗模式是否因种族而异。这是一项对2017年1月1日至2020年6月30日期间在美国任何VHA机构接受durvalumab治疗的不可切除III期NSCLC的白色和黑人成人患者进行的回顾性分析。采集的数据包括基线特征和durvalumab治疗模式，包括治疗开始延迟（TID）、中断（TI）和停药（TD）;分别定义为CRT完成至durvalumab开始超过42天、durvalumab输注间隔超过28天、距离durvalumab末次给药超过28天且未重新开始durvalumab。还收集了剂量、治疗持续时间和不良事件。本研究共纳入924例患者（白色= 726例;黑色= 198例）。在TID（OR，1.39; 95%CI，0.81-2.37）、TI（OR，1.58; 95%CI，0.90-2.76）或TD（OR，0.84; 95%CI，0.50-1.38）的多变量逻辑回归模型中，种族不是一个重要因素。中位数也没有显著差异，（四分位距[IQR]）给药次数（白色：15 [7-24]，黑人：18 [7-25]; P = .25）或中位（IQR）治疗持续时间（白色：8.7个月[2.9-11.8]，黑色：9.8个月[3.6-12.0]; P = .08），尽管黑人患者发生免疫相关不良事件的可能性较小（28% vs. 36%，P = .03），发生肺炎的可能性较小（7% vs. 14%，P < .01）。在这项在VHA接受durvalumab治疗的不可切除III期NSCLC患者的真实世界研究中，未发现人种与TID、TI或TD相关。在美国，黑人患者承担着不成比例的肺癌负担，但在具有里程碑意义的免疫治疗试验中代表性不足。这项分析是第一项评估种族与durvalumab临床使用之间关系的研究。
Real-world evidence is limited regarding the relationship between race and use of durvalumab, an immunotherapy approved for use in adults with unresectable stage III non-small cell lung cancer (NSCLC) post-chemoradiotherapy (CRT). This study aimed to evaluate if durvalumab treatment patterns differed by race in patients with unresectable stage III NSCLC in a Veterans Health Administration (VHA) population. This was a retrospective analysis of White and Black adults with unresectable stage III NSCLC treated with durvalumab presenting to any VHA facility in the US from January 1, 2017, to June 30, 2020. Data captured included baseline characteristics and durvalumab treatment patterns, including treatment initiation delay (TID), interruption (TI), and discontinuation (TD); defined as CRT completion to durvalumab initiation greater than 42 days, greater than 28 days between durvalumab infusions, and more than 28 days from the last durvalumab dose with no new durvalumab restarts, respectively. The number of doses, duration of therapy, and adverse events were also collected. A total of 924 patients were included in this study (White = 726; Black = 198). Race was not a significant factor in a multivariate logistic regression model for TID (OR, 1.39; 95% CI, 0.81-2.37), TI (OR, 1.58; 95% CI, 0.90-2.76), or TD (OR, 0.84; 95% CI, 0.50-1.38). There were also no significant differences in median (interquartile range [IQR]) number of doses (White: 15 [7-24], Black: 18 [7-25]; P = .25) or median (IQR) duration of therapy (White: 8.7 months [2.9-11.8], Black: 9.8 months [3.6-12.0]; P = .08), although Black patients were less likely to experience an immune-related adverse event (28% vs. 36%, P = .03) and less likely to experience pneumonitis (7% vs. 14%, P < .01). Race was not found to be linked with TID, TI, or TD in this real-world study of patients with unresectable stage III NSCLC treated with durvalumab at the VHA. Black patients shoulder a disproportionate share of the lung cancer burden in the US but are underrepresented in landmark immunotherapy trials. This analysis is the first study to evaluate the relationship between race and the clinical use of durvalumab.
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