Some oncology practices are less likely than others to adopt immunotherapies within 2 years of regulatory approval, according to research published in JAMA Oncology.

Rural practices, practices with 5 or fewer physicians, and independent/nonacademic practices were all less likely to adopt immunotherapies within 2 years of US Food and Drug Administration (FDA) approval, researchers found.

For this study, the researchers analyzed Medicare claims data for beneficiaries who received infused or oral chemotherapy from 2010 to 2017. The patients had 1 of 4 cancer types for which immunotherapies were approved by the FDA between 2011 and 2016 — melanoma (first approval in 2011), kidney cancer (2015 approval), lung cancer (2015 approval), and head and neck cancer (2016 approval).

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A total of 1732 oncology practices were included in the analysis. More than half of practices (52%) were independent, 15% were rural, and 28% were smaller, which was defined as employing 1 to 5 physicians.

The data showed that, within 6 months of FDA approval, a weighted 9% of practices with melanoma episodes had adopted immunotherapy, as had 51% of practices with lung cancer episodes, 62% with kidney cancer episodes, and 56% with head and neck cancer episodes.

Most practices had adopted immunotherapy within 2 years of FDA approval. At the 2-year mark, a weighted 76% of practices with melanoma episodes had adopted immunotherapy, as had 95% of practices with lung cancer episodes and 81% with kidney cancer episodes. Head and neck cancer episodes were not observed 2 years after approval, as the approval date for head and neck cancer was 2016.

“For some cancer types, immunotherapy adoption began before FDA approval, in part reflecting off-label use of drugs that had been approved for other cancers,” the researchers noted.

When the researchers looked at adoption of approved immunotherapies by practice type, they found that adoption was:

  • 11 percentage points lower at rural practices than at urban practices
  • 27 percentage points lower at practices with 1 to 5 physicians than at practices with 6 or more physicians
  • 6 percentage points lower in independent practices than in academic systems
  • 9 percentage points lower in nonacademic systems than in academic systems.

“In this cohort study, adoption of immunotherapy by oncology practices occurred rapidly after FDA approval,” the researchers wrote. “However, adoption varied across practice types, with lower adoption at rural practices and small practices and higher adoption at academic systems. Future work could usefully measure the benefits and costs of adoption across practice types, which was not observable in the data used in this study.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Carroll CE, Landrum MB, Wright AA, Keating NL. Adoption of innovative therapies across oncology practices — Evidence from immunotherapy. JAMA Oncol. Published online January 5, 2023. doi:10.1001/jamaoncol.2022.6296