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

Background

CheckMate 577 demonstrated a significant benefit with adjuvant nivolumab for those with residual disease after esophagectomy following chemoradiation, resulting in subsequent Food and Drug Administration approval and guideline inclusion. We analyzed adherence to this recommendation in a nontrial setting and assessed for factors associated with noncompliance within our health care system.

Methods

We performed a cross-sectional analysis of patients with esophageal cancer within a multistate community health care system between February 2021 and December 2022. Patients with resected residual disease following induction chemoradiation were included. Patients were assigned to categories of those offered nivolumab and those not, then assessed for demographic, socioeconomic, or clinical factors associated with nonadherence. Area Deprivation Index was used as surrogate for socioeconomic status. Patients completing year-long nivolumab were then compared with those discontinuing prematurely for factors associated with noncompletion.

Results

Of the 73 patients eligible for nivolumab, 67 (92%) were offered therapy. Not being offered nivolumab was associated with receiving care from medical oncologists located in more disadvantaged communities. Of patients offered nivolumab, 57 of 67 (85%) initiated treatment. Year-long immunotherapy was completed by 25 (48%) patients. Patients with node-positive disease were more likely to have completed year-long nivolumab.

Conclusions

In the first 2 years after CheckMate 577, results within our health care system suggest high clinician adherence to and patient acceptance of adjuvant immunotherapy with decreased adoption in more socioeconomically challenged oncology offices. In addition, compliance with the year-long adjuvant regimen mirrored clinical trial results. These results warrant further validation in a more diverse, less affluent population.