Predictors Of Erlotinib Utilization And The Impact Of Erlotinib Use On Overall Survival In Advanced, Non-Small Cell Lung Cancer.

e18741 Background: Epidermal growth factor receptor (EGFR)-directed therapies are approved for selected patients with non-small cell lung cancer (NSCLC); however, little information on predictors of utilization and efficacy in the population-based setting has been reported. We aimed to identify predictors of early erlotinib prescribing and evaluate the impact of erlotinib on survival in patients diagnosed with stage IIIB/IV NSCLC residing in South Carolina (SC). Methods: SC Central Cancer Registry cases diagnosed between January 1, 2002 and December 31, 2012 were linked to SC State Employee Health Plan (SCSEHP) and Medicaid administrative claims data. Logistic regression (LR) was used to identify predictors of erlotinib utilization. Kaplan-Meier methods were used to estimate survival distributions and log-rank tests compared the survival distributions between erlotinib groups. Cox proportional hazards (PH) modeling was used to assess the impact of patient demographic, disease, and treatment characteristics on survival, while adjusting for other prognostic covariates. Multivariable LR models were used to estimate propensity scores, which were then used as covariates in adjusted Cox PH models. Results: A total of 1,623 patients were eligible. Independent predictive factors for having at least one erlotinib claim, included younger age at diagnosis (p = .004), female sex (p = .048), SCSEHP (p < .001), out-of-state providers (p < .001), adenocarcinoma histology (p < .001), and having molecular testing (p = .018). Overall survival (OS) was longer for patients who received erlotinib (median OS = 14 versus 7 months, p < 0.001). After adjustment for significant prognostic factors, patients who received erlotinib had a 35% reduced risk of death compared to patients with no erlotinib (HR = 0.65, 95% CI: 0.56-0.75, p < .001). Conclusions: Several factors were associated with erlotinib utilization and disparities in access may exist. Erlotinib utilization was associated with a reduced risk of death in patients with NSCLC in SC.