Disparities and Trends in Rates of Genetic Testing and Erlotinib Treatment Among Metastatic Non-Small Cell Lung Cancer Patients
Menée à partir de données portant sur 9 900 patients atteints d'un cancer du poumon non à petites cellules de stade métastatique diagnostiqué entre 2007 et 2011, cette étude analyse l'évolution des disparités (socioéconomiques, ethniques, liées au sexe, etc.) dans l'utilisation de tests génétiques et dans l'accès à un traitement par erlotinib
Background: Despite reports of socioeconomic disparities in rates of genetic testing and targeted therapy treatment for metastatic non-small cell lung cancer (NSCLC), little is known about whether such disparities are changing over time. Methods: We performed a retrospective analysis to identify disparities and trends in genetic testing and treatment with erlotinib. Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we identified 9,900 stage 4 NSCLC patients diagnosed in 2007-2011 at age 65 or older. We performed logistic regression analyses to identify patient factors associated with odds of receiving a genetic test and erlotinib treatment, and to assess trends in these differences with respect to diagnosis year. Results: Patients were more likely to receive genetic testing if they were under age 75 at diagnosis (odds ratio [OR]=1.55) independent of comorbidity level, and this age-based gap showed a decrease over time (OR=0.93). For untested patients, erlotinib treatment was associated with race (OR=0.58, black vs. white; OR=2.45, Asian vs. white), and was more likely among female patients (OR=1.45); for tested patients, erlotinib treatment was less likely among low-income patients (OR=0.32). Most of these associations persisted or increased in magnitude. Conclusions: Race and sex are associated with rates of erlotinib treatment for patients who did not receive genetic testing, and low-income status is associated with treatment rates for those who did receive testing. The racial disparity remained stable over time, while the income-based disparity grew larger. Impact: Attention to reducing disparities is needed as precision cancer treatments continue to be developed.