First-line treatment patterns of advanced non–small cell lung cancer in patients with and without pre-existing autoimmune diseases.

Abstract

e20626 Background: Immune checkpoint inhibitors (ICIs) are established first-line therapies for advanced NSCLC (aNSCLC). However, ICIs carry a risk of immune-mediated adverse events, and patients (pts) with autoimmune diseases (AID) may be at heightened risk of disease flare or new symptoms of autoimmunity. As a result, pts with pre-existing AIDs have been excluded from clinical trials, and their treatment patterns in the real world are not well-described. This study aimed to elucidate drug utilization patterns in first-line (1L)-treated aNSCLC pts, with and without pre-existing AIDs. Methods: Using the Optum Enriched Oncology dataset, pts (≥18 years) with aNSCLC (stage IIIB/C or IV) treated with either ICIs (alone or in combination with other therapies, including chemotherapy) or chemotherapy alone, not restricted to platinum-containing agents, in the 1L setting between 10 May 2017 and 1 March 2025 were identified. Pts with prior receipt of a targeted therapy for NSCLC or an actionable mutation were excluded. Pre-existing AID was operationalized using either ICD-10 codes or NLP-derived terms on or before (≤365 days) the date of 1L treatment initiation, and further stratified into high- and low-risk AIDs based on the risk of flares associated with the specific underlying AID. Results: Clinical and demographic characteristics were comparable between pts with AID (N = 779) and those without AID (N = 6,186), except for sex, where a higher proportion of females was observed in the AID group (54% vs. 45%). Among pts without AID, 62.7% received 1L ICI treatment and 37.3% received chemotherapy, which remained relatively stable over time (Table). Pts with low-risk AIDs showed similar proportions, with 62.2% receiving ICIs and 37.8% receiving chemotherapy. In contrast, a lower proportion of pts with high-risk AIDs received an ICI (51.6%). Utilization rates were heterogenous across specific AIDs, and certain high-risk AIDs, such as Crohn’s disease (41.7%) and multiple sclerosis (25.0%), show markedly lower rates of ICI utilization compared to the overall proportion observed among all high-risk pts. Conclusions: Similar patterns of predominant ICI utilization were observed among pts without AID and those with low-risk AID. In contrast, fewer pts with high-risk AID received ICIs, implying that risk status in these pts may be guiding treatment decisions. However, approximately half of the high-risk pts are still treated with ICIs, suggesting that prescribers are often comfortable using ICIs in pts with pre-existing AID. Temporal trends for 1L treatment for NSCLC, by AID status. AID No AID Year N Chemotherapy ICI N Chemotherapy ICI 2017 74 66% 34% 561 60% 40% 2018 105 46% 54% 888 46% 54% 2019 107 41% 59% 935 33% 67% 2020 98 44% 56% 914 34% 66% 2021 92 50% 50% 858 34% 66% 2022 90 43% 57% 675 33% 67% 2023 88 38% 63% 653 30% 70% 2024 110 34% 66% 603 33% 67% 2025 15 47% 53% 99 37% 63%