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Overall Survival of Elderly Patients with Non-Small Cell Lung Cancer Treated with Programmed Death-1 (PD-1) Inhibitors and Microbiome Altering Medications: A Retrospective Analysis Using the SEER-Medicare Database

Hughes, Valerie
http://orcid.org/0000-0001-8234-8489
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1692293042036511

Abstract Details

2023, PhD, University of Cincinnati, Pharmacy: Pharmaceutical Sciences.
Background: Immune checkpoint inhibitors (ICI) have advanced the treatment of patients with non-small cell lung cancer (NSCLC), melanoma, renal cell carcinoma, and other cancers; however, the benefit to patients can vary significantly.1 Real-world data has shown that not all patients respond the same to ICI treatment and even less is known for aging patients that may have co-morbidities, altered gut microbiome, and multiple concomitant medications. Understanding the effect of medications known to alter the microbiome in lung cancer patients who receive ICI treatments has shown to be of importance. The objective of this study is to evaluate overall survival in elderly lung cancer patients receiving a type of ICI, programmed death-1 (PD-1) inhibitors, and medications known to impact the gut microbiome. Methods: Surveillance, Epidemiology, and End Results (SEER)-Medicare is a publicly available database that links the SEER tumor registry data with Medicare enrollment and claims files. A retrospective observational study design was conducted to estimate the overall survival of elderly patients with NSCLC that use antibiotics and ICI medications, focusing on PD-L1 inhibitors, nivolumab and pembrolizumab. The study cohort was determined based on lung cancer histology, claims for nivolumab or pembrolizumab, and continuous enrollment. Claims for outpatient antibiotics or proton pump inhibitors (PPIs) were identified in the Part D file and assigned to 14-day, 30-day, or 60-day comparison groups. Patients with no antibiotic claim within 180 days of initiating ICI therapy were assigned to a control group. We will estimate the effect of concomitant use of PD-1 inhibitors and antibiotics or PPIs on overall survival using Kaplan-Meier and Cox proportional hazards regression models. Results: We identified 3,445 patients that had lung cancer and received PD-1 inhibitors, of whom 1,702 (49%) received an antibiotic and 484 (14%) received a PPI within 60 days of starting the ICI therapy. The median age of the patient at the time of the lung cancer diagnosis was 73 years (interquartile range [78-69]. The average time to initiate PD-1 treatment from the time of lung cancer diagnosis was 5.8 months. Patients who received an oral antibiotic in the outpatient setting mainly received a broad-spectrum antibiotic, commonly penicillin or quinolones. Conclusion: The difference in overall survival reported between users of medications known to cause disruption to the gut microbiome and non-users is consistent with current literature. Utilization of immunotherapy is increasing in the Medicare population and these patients commonly have age-related changes to the immune systems and microbiome. These results provide overall survival estimates for older patients with NSCLC treated with PD-1 and receiving medications known to alter important gut microbiome diversity.
Ana Hincapie, Ph.D. (Committee Chair)
Jianfei (Jeff) Guo, Ph.D. (Committee Member)
Eric Vick, M.D. Ph.D. (Committee Member)
Alex Lin, Ph.D. (Committee Member)
Rowena Schwartz (Committee Member)
Roman Jandarov, Ph.D. (Committee Member)
130 p.
Pharmaceuticals
Immune Checkpoint Inhibitors; Lung Cancer; Survival Outcomes; SEER-Medicare

Recommended Citations

Citations

  • Hughes, V. (2023). Overall Survival of Elderly Patients with Non-Small Cell Lung Cancer Treated with Programmed Death-1 (PD-1) Inhibitors and Microbiome Altering Medications: A Retrospective Analysis Using the SEER-Medicare Database [Doctoral dissertation, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1692293042036511

    APA Style (7th edition)

  • Hughes, Valerie. Overall Survival of Elderly Patients with Non-Small Cell Lung Cancer Treated with Programmed Death-1 (PD-1) Inhibitors and Microbiome Altering Medications: A Retrospective Analysis Using the SEER-Medicare Database. 2023. University of Cincinnati, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1692293042036511.

    MLA Style (8th edition)

  • Hughes, Valerie. "Overall Survival of Elderly Patients with Non-Small Cell Lung Cancer Treated with Programmed Death-1 (PD-1) Inhibitors and Microbiome Altering Medications: A Retrospective Analysis Using the SEER-Medicare Database." Doctoral dissertation, University of Cincinnati, 2023. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1692293042036511

    Chicago Manual of Style (17th edition)

ucin1692293042036511
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© 2023, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.