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Neurooncol Adv
Neurooncol Adv
noa
Neuro-Oncology Advances
2632-2498
Oxford University Press US

10.1093/noajnl/vdae090.111
vdae090.111
Final Category: Research Methods and Trial Design Considerations
AcademicSubjects/MED00300
AcademicSubjects/MED00310
RMTD-04 EXAMINING THE REAL-WORLD CUMULATIVE INCIDENCE OF BRAIN METASTASES IN US MEDICARE ALK+ METASTATIC NON-SMALL CELL LUNG CANCER (MNSCLC) PATIENT POPULATIONS THAT ARE UNDERREPRESENTED IN RANDOMIZED CLINICAL TRIALS
Abrahami Devin Pfizer Inc, New York, USA

Sang Angela Pfizer Inc, New York, USA

Davis Matthew Medicus Economics, MA, USA

Marcum Zachary Medicus Economics, MA, USA

Rifi Nada Pfizer Inc, New York, USA

Li Benjamin Pfizer Inc, New York, USA

Duncan Kirsten Pfizer Inc, New York, USA

Kelton John Pfizer Inc, New York, USA

Uprety Dipesh Karmanos, MI, USA

Bazhenova Lyudmila UCSD, CA, USA

8 2024
02 8 2024
02 8 2024
6 Suppl 1 2024 SNO/ASCO CNS Metastases Conference i34i34
© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Abstract

Brain metastases (BM) are a serious outcome for patients with ALK+ mNSCLC and may occur at diagnosis (baseline) or during disease progression (incident). Gaps in understanding the impact of BM remain, especially in populations that are underrepresented in randomized clinical trials (RCTs). Using a 100% sample of Medicare fee-for-service and Medicare Advantage beneficiaries from 2017-2022, patients >65 years with ALK + mNSCLC (index date = first-line alectinib/brigatinib initiation) were identified. Patient characteristics were compared to pivotal RCTs. BM were assessed as occurring at diagnosis if there was a record in the year prior to the index date (baseline), while BM during progression were observed from the index date forward among those without baseline BM. The incidence of BM by age and racial/ethnic group was estimated using a cumulative incidence function accounting for the competing risk of death within strata of the population. In the study cohort, 988 (95%) and 53 (5%) of patients were initiated on alectinib and brigatinib, respectively, and 290/1041 (28%) and 126/751 (17%) had baseline or incident BM, respectively. In contrast to published RCTs, the median age in this study was 74 years, with 10% of the patients ≥85 years at baseline, and 32% of patients were non-White (Black: 8%, Asian/Pacific Islander: 12%, Hispanic: 8%). After 4 years from the index date, the cumulative incidence of BM was highest in patients ≥85 years (25%), compared to 19% and 18% in patients <75 and 75-84 years, respectively. The cumulative incidence of BM was higher in non-White patients (23%) compared to White patients (17%). This study demonstrated a higher cumulative incidence of BM among US Medicare populations in the real-world setting that are underrepresented in RCTs. More work is needed to ensure adequate representation of patients in RCTs to further inform safety and efficacy data in broader populations.
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pmc
