Retrospective Study Shows Adoption of Immunotherapy in ES-SCLC

Eric Nadler, MD, MPP, the medical director of Health Informatics and Internet Technology for The US Oncology Network and an oncologist at Texas Oncology, discusses the design and goals of a retrospective study of real-world adoption of atezolizumab (Tecentriq) immunotherapy in extensive-stage small cell lung cancer (ES-SCLC).

The IMpower133 trial (NCT02763579) showed efficacy of the combination of atezolizumab, carboplatin, and etoposide in patients with ES-SCLC. Nadler and other investigators researched how community oncologists adopted chemoimmunotherapy based onthe iKnowMed electronic health record data.

Nadler says the goals of this study were to see how quickly the regimen was adopted and how much efficacy it had a real-world population that included patients who would not have been accepted into the clinical study due to age or poor health.

According to Nadler, they collected data about patients with ES-SCLC from October 2018 through December 31, 2019 to see how physicians adopted the regimen following its first presentation, and identified 267 patients who received chemoimmunotherapy with atezolizumab, while finding that only 23% as many patients received chemotherapy alone.

The retrospective study found that oncologists adopted the regimen fairly quickly after the clinical data were published, and that was tolerable in the real-world population that included patients with comorbidities.

TRANSCRIPTION:

0:08 | Basically, we wanted to study 2 things. We wanted to look at the adoption pattern of immunotherapy in the community after the publication and presentation of IMpower133. So, we wanted to see how quickly it would take doctors in a large community network, the largest community network, to actually begin to bring in immunotherapy into their practice.

And, secondarily, to be honest, we wanted to look at the efficacy of it, and see if you extend it to real world patients which tend to be sicker and older and have a lot more comorbidities. They don't have the same stringency of entry criterion when you offer that type of therapy in clinical trials. It’s very stringent which types of patients you're allowed to offer therapy to. But in the community, you can offer it to anybody you think is appropriate. So, that was a background of why we did it.

We did it—the dates of the study were between October 2018 through December 31, 2019. So, basically, the moment [Impower133] was presented, even before it's FDA approved, for about an 18 month follow up. We looked at just under 350 patients who received that regimen. And once we audited the data, 267 were found to actually have chemo immunotherapy with [atezolizumab]. And we did have a competitor arm, just to kind of look at and engage it, and it was a quarter of the percentage; 23% had [chemotherapy] alone.