BACKGROUND: Approximately 17% of patients with non-small cell lung cancer (NSCLC) have epidermal growth factor receptor mutations (EGFRm). Amivantamab received United States Food and Drug Administration approvals in advanced NSCLC for patients with EGFR exon 20 insertions (exon20ins) who progressed after platinum-based chemotherapy (PBC) on 05/21/2021, for first-line (1 L) EGFR exon20ins on 03/01/2024, and for 1 L and second-line or later (2 L+) EGFR exon 19 deletion and L858R on 08/20/2024 and 09/19/2024, respectively. This claims-based study describes real-world treatment patterns and healthcare resource utilization (HRU) among insured patients with advanced NSCLC initiating amivantamab in 2 L or later (2 L+). METHODS: Komodo Research Data closed claims (01/01/2016-10/31/2023) were used to analyze insured adults with a diagnosis of lung cancer who initiated amivantamab on/after 05/21/2021 in 2 L+. Treatment patterns, including prior PBC and immunotherapy (IO) use, were described by line of therapy (LOT). All-cause HRU per-patient-per-month (PPPM) was assessed during the amivantamab LOT and all LOTs preceding amivantamab. Time to next treatment or death (TTNT-D) was reported using Kaplan-Meier analysis for each LOT. RESULTS: Overall, 126 patients initiated amivantamab in 2 L+ (mean age: 60.2 years, 63.5% female). Amivantamab was initiated in 2 L by 51.6% of patients, while 32.5% and 15.9% initiated amivantamab in third-line (3 L) and fourth-line or later (4 L+), respectively. Most patients initiated amivantamab as monotherapy (2 L: 92.3%; 3 L: 73.2%; 4 L+: 80.0%), had prior PBC use (2 L: 83.1%; 3 L: 100.0%; 4 L+: 100.0%), and prior IO use (2 L: 60.0%; 3 L: 63.4%; 4 L+: 85.0%). Mean outpatient service use was 5.87 days PPPM before amivantamab initiation and 6.79 days PPPM during amivantamab treatment. Mean inpatient admissions PPPM were 0.05 before amivantamab and 0.08 during amivantamab treatment. Among patients initiating amivantamab in 2 L, 3 L, or 4 L+, median TTNT-D was 11.0 months, 5.3 months, and 6.1 months, respectively. CONCLUSIONS: Among insured patients with advanced NSCLC receiving amivantamab in 2 L+, TTNT-D aligned with results reported in clinical trials. Before initiating amivantamab, most patients received IO, despite IO use being inconsistent with treatment guidelines and limited demonstrated benefit. HRU was similar before and during amivantamab treatment, suggesting that amivantamab does not contribute to an increase in medical services compared to treatment regimens used in earlier LOTs.
Waterhouse et al. (Thu,) studied this question.