Adherence to CheckMate 577 Within a Community Health Care System in the First 2 Years After Approval.

Area of Science:

• Oncology
• Immunotherapy
• Health Services Research

Background:

• The CheckMate 577 trial established adjuvant nivolumab as beneficial for esophageal cancer patients with residual disease after esophagectomy and chemoradiation.
• This led to FDA approval and inclusion in clinical guidelines, necessitating real-world adherence assessment.
• Analysis focuses on noncompliance factors within a community healthcare system in a non-trial setting.

Purpose of the Study:

• To analyze adherence to adjuvant nivolumab recommendations in a real-world, non-trial setting.
• To identify demographic, socioeconomic, and clinical factors associated with noncompliance.
• To assess factors influencing completion of the year-long nivolumab regimen.

Main Methods:

• Cross-sectional analysis of esophageal cancer patients within a multistate community healthcare system (February 2021 - December 2022).
• Inclusion criteria: resected residual disease post-induction chemoradiation.
• Assessment of nivolumab offer status, initiation, completion, and associated factors (including Area Deprivation Index for socioeconomic status).

Main Results:

• Of 73 eligible patients, 67 (92%) were offered nivolumab; non-offer was linked to care in more disadvantaged communities.
• 57 of 67 (85%) offered nivolumab initiated treatment.
• 25 (48%) completed the year-long regimen; node-positive disease was associated with higher completion rates.

Conclusions:

• High clinician adherence and patient acceptance of adjuvant nivolumab were observed, but adoption was reduced in socioeconomically challenged oncology settings.
• Treatment compliance mirrored clinical trial findings.
• Further validation in diverse, less affluent populations is warranted.