Fellowship for Noor Naffakh:The Prevalence of Zoledronic Acid, Pamidronate, and Denosumab Use in Patients with Metastatic

With a current 5-year survival rate of around 18.6%, lung cancer is the leading cause of cancer death and the second most commonly diagnosed cancer in the world. Although the prognosis of the disease seems grim, survival rates have shown a steady increase since the 1980s with a concomitant decrease in incidence over the last 10 years by approximately 2.1%. For patients with targetable mutations, immunologic and targeted therapies have significantly increased the expected progression free survival and/or overall survival for metastatic NSCLC as compared to standard chemotherapy. Additionally, their recent FDA approval for NSCLC has increased accessibility, showing further promise in improving overall likelihood of prolonged survival. As many of these therapies show an increased overall survival time in this population, maintaining a good quality of life (QOL) becomes essential in those additional months. One main goal is preventing skeletal related events (SREs) for as long as possible with the use of medications such as denosumab, zoledronic acid, and pamidronate. There appears to be two studies that have assessed the prevalence and characteristics of metastatic NSCLC patients utilizing bone therapy medication. The first study looked at IV zoledronic acid or pamidronate administration prior to (prophylactic use) or after an SRE in breast, prostate, and lung cancers using data from 2 large US health systems from 1/1/1995 to12/31/2009. The authors identified 332 patients with lung cancer and bone metastases, and determined that only 14.8% of those patients received IV bisphosphonates. The prevalence of denosumab use was not evaluated. The second study by Hagiwaria et. al utilized the Truven Health MarketScan® Commercial and Medicaredatabases from 2002-2011. This study was published in 2014 and the authors claim to be the first to characterize IV bone medication “practice patterns” in lung, prostate, and breast cancer patients with bone metastases using ICD-9 codes. This study found similar results as the one mentioned above. Of the three solid tumor disease states examined, lung cancer appeared to be utilizing IV bone medications the least (33% vs 59% for breast and 43% for prostate). Denosumab was also dropped from this analysis. The goal of this research is to assess the national prevalence of antiresorptive bone therapy use in the non-small cell lung cancer population, with a particular interest in recent trends of usage post-FDA approval of many new immunologic and targeted agents. Additionally, some targeted therapies have shown synergistic effects alongside bone-health medications with respect to tumor response and survival time; making the effect of their combinations an interesting point for exploration. Finally, there is anecdotal evidence from a local hospital that these medications are currently only being given to 20% of eligible non-small cell lung cancer patients. Although this statistic will need to be investigated further, it is important to assess the prevalence of use in a wider population (eg. Truven patients- secondary database) and then subsequently compare it to our facility (not comparing IV bone medication use to a gold standard EHR is a stated limitation of previous prevalence studies).