Effects of cancer medications shortage on the survival of patients with lung cancer: A multicenter study in Lebanon.

Abstract

e20540 Background: Globally, lung cancer remains the leading cause of cancer-related deaths despite the fact that its treatment has evolved tremendously with Immunotherapy introduction. Cancer medications became markedly unavailable during the severe economic crisis that Lebanon experienced in the past few years, forcing oncologists to adjust the treatment protocols and dosages based on medications availability. This study aims to assess the effect of medication shortage on progression-free survival (PFS) of lung cancer patients treated at four tertiary care centers in Lebanon: American University of Beirut Medical Center, Lebanese American University Medical Center-Rizk Hospital, Saint Georges Hospital University Medical Center, and Saint Joseph University Medical Center. Methods: A retrospective study comparing outcomes of patients with metastatic non-small cell lung cancer (NSCLC) treated during the period of drug shortage between October 2021 and December 2022 (crisis group), with those of patients treated between 2019 and 2020 (control group) where medications were still available. The primary end point was PFS on first line therapy and its association with dose density (DD) ratio (dose density administered divided by the standard dose density). The study protocol was approved by institutional review board of each institution. Electronic or conventional medical records of 200 patients were reviewed among the four medical centers and data of 134 eligible patients were collected and analyzed using IBM SPSS software. Results: The median age at diagnosis was 69 years. Out of total patients, 57.5% were males and 42.5% were females. Sixty-seven patients were eligible in control group versus 67 eligible patients in crisis group. 17.2% received chemotherapy, 36.6% received immunotherapy and 46.2% received a combination of chemo-immunotherapy. 76.1% of patients had opportunity to receive immunotherapy. Among patients who received immunotherapy, forty-seven patients (46%) received a full dose of immunotherapy with a DD ratio of 1 with a median PFS of 6 months. Forty-two patients (41.17%) received a DD ratio of 0.51-0.99 with a median PFS of 12 months and thirteen patients (12.7%) received of 0.01 to 0.50 with a median PFS of 10 months. Unlike our initial expectations, there was no statistically significant difference between immunotherapy DD and PFS with a p-value of 0.114. Conclusions: To our knowledge this is the first multi-center study in Lebanon and MENA region to compare immunotherapy DD and PFS in patients with metastatic NSCLC. Despite remarkable shortages in immunotherapy medications during crisis, our multi-center study suggests no significant detrimental effect on PFS. This unexpected finding, as recent data, challenges conventional practice of full dose immunotherapy, prompting further investigation of the relationship between immunotherapy dosage and patients’ outcome.