美国退伍军人事务部接受 durvalumab 治疗不可切除的 III 期非小细胞肺癌患者的健康公平性。
Health Equity in Patients Receiving Durvalumab for Unresectable Stage III Non-Small Cell Lung Cancer in the US Veterans Health Administration.
机构信息
Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, San Antonio, TX, USA.
Pharmacotherapy Education and Research Center, Department of Medicine, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA.
出版信息
Oncologist. 2023 Sep 7;28(9):804-811. doi: 10.1093/oncolo/oyad172.
BACKGROUND
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.
MATERIALS AND METHODS
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.
RESULTS
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).
CONCLUSION
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.
背景
关于种族与 durvalumab 应用之间的关系，真实世界的数据十分有限。durvalumab 是一种免疫疗法药物，已被批准用于接受过放化疗（CRT）的不可切除 III 期非小细胞肺癌（NSCLC）成年患者。本研究旨在评估在退伍军人健康管理局（VHA）人群中，不可切除 III 期 NSCLC 患者使用 durvalumab 时，种族是否会影响其治疗模式。
材料与方法
这是一项回顾性分析，纳入了自 2017 年 1 月 1 日至 2020 年 6 月 30 日期间，在 VHA 美国任何机构就诊的不可切除 III 期 NSCLC 成年白人（726 例）和黑人（198 例）患者。纳入患者均接受 durvalumab 治疗。数据采集包括基线特征和 durvalumab 的治疗模式，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 起始时间超过 42 天、durvalumab 输注间隔超过 28 天、最后一次 durvalumab 剂量后超过 28 天且无新的 durvalumab 重新开始。还收集了用药剂量、治疗持续时间和不良事件。
结果
本研究共纳入 924 例患者（白人=726 例，黑人=198 例）。在多变量逻辑回归模型中，种族并不是 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）的显著影响因素。黑人患者的中位（四分位距[IQR]）用药剂量（白人：15 [7-24]，黑人：18 [7-25]；P=.25）和中位（IQR）治疗持续时间（白人：8.7 个月 [2.9-11.8]，黑人：9.8 个月 [3.6-12.0]；P=.08）也无显著差异，尽管黑人患者发生免疫相关不良事件的比例较低（28% vs. 36%，P=.03），发生肺炎的比例较低（7% vs. 14%，P<.01）。
结论
在 VHA 接受 durvalumab 治疗的不可切除 III 期 NSCLC 患者中，种族与 TID、TI 或 TD 无关。
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