Comorbidities and concomitant medication use in patients with TKI-naive, advanced, or metastatic ALK-positive NSCLC.

Abstract

e20737 Background: Recommended therapies for anaplastic lymphoma kinase positive (ALK+) non-small cell lung cancer (NSCLC) are ALK-tyrosine kinase inhibitors (TKI). We aimed to understand the challenges in patient management by evaluating comorbidities and medications observed before and after treatment initiation among TKI-naïve patients, receiving alectinib, brigatinib, or lorlatinib (i.e., 1L TKIs). Methods: Adult (≥18 years) patients treated with 1L alectinib, brigatinib or lorlatinib between 1/1/2020-12/3/2023 were identified in the Komodo Healthcare Map claims database. Patients had ≥6 months of continuous enrollment prior to and after the date of 1L initiation (i.e., index date [ID]). Comorbidities, concomitant medications and total medical costs were evaluated over the 6 months pre- and post-ID. Comorbidities and concomitant medications of interest were curated with clinician input. Comorbidities were identified by International Classification of Diseases, 10 th Revision codes and treatment. Concomitant medications were identified using the first 4 to 6 digits of the Generic Product Identifier. Analyses were descriptive. Results: 815 patients were included (mean age: 58.6 years) and median follow up days were 558, 577, and 480 for alectinib, brigatinib, and lorlatinib, respectively. The proportion of patients with evidence of hyperlipidemia slightly decreased post-ID in patients treated with alectinib (47.4% pre-ID; 41.7% post-ID) or brigatinib (34.0% pre-ID; 29.8% post-ID) and increased in patients treated with lorlatinib (47.3% pre-ID; 96.4% post-ID). Post-index changes in other select comorbidities, and use of concomitant medications are detailed in the table. Mean total medical costs decreased post-ID, from $11223 to $5090 for alectinib, $6997 to $3176 for brigatinib, and $7577 to $3421 for lorlatinib. Conclusions: Results showed a high burden of disease management prior to initiating 1L ALK-TKI therapy. Variability in changes to disease management burden were observed by 1L treatment choice, which may reflect differences in agent-specific tolerability profiles. These results highlight the importance of using a personalized approach to therapy. Comorbidities (all grade)/concomitant medications 1L AlectinibN=713 (87.5%) 1L BrigatinibN= 47 (5.8%) 1L LorlatinibN=55 (6.7%) Pre-ID, Post-ID% delta Pre-ID, Post-ID% delta Pre-ID, Post-ID% delta Elevated liver enzymes 4.2, 9.3 5.0 6.4, 19.1 12.8 7.3, 3.6 -3.6 Peripheral edema 8.3, 18.2 10.0 8.5, 12.8 4.3 5.5, 30.9 25.5 Peripheral neuropathy 15.7, 13.7 -2.0 23.4, 15.0 -8.5 16.4, 30.9 14.5 Anti-emetics 59.0, 32.8 -26.2 46.8, 44.7 -2.1 49.1, 20.0 -29.1 Benzodiazepines 24.8, 19.6 -5.2 38.3, 23.4 -14.9 18.2, 21.8 3.6 Antipsychotics/anti-manics 36.5, 18.9 -17.5 25.5, 34.0 8.5 32.7, 20.0 -12.7 Proton pump inhibitors 40.4, 27.6 -12.8 34.0, 36.2 2.1 49.1, 30.9 -18.2 Statins 29.6, 27.6 -2.0 21.3, 25.5 4.3 34.6, 78.2 43.6