Time toxicity for patients receiving oral versus parenteral hypomethylating agents for myelodysplastic syndromes/neoplasms (MDS).

person Robert S Epstein Epstein Health, LLC, Woodcliff Lake, NJ info_outline Robert S Epstein, Amer Methqal Zeidan, Abisola Olopoenia, Halley Costantino, Kushal Modi, Tehseen Salimi, Terri Washington, JoAnn Krenitsky

Authors person Robert S Epstein Epstein Health, LLC, Woodcliff Lake, NJ info_outline Robert S Epstein, Amer Methqal Zeidan, Abisola Olopoenia, Halley Costantino, Kushal Modi, Tehseen Salimi, Terri Washington, JoAnn Krenitsky Organizations Epstein Health, LLC, Woodcliff Lake, NJ, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, Oracle Life Sciences, Austin, TX, Taiho Oncology Inc., Princeton, NJ Abstract Disclosures Research Funding Taiho Oncology, Inc. Background: Patients spend substantial time receiving cancer care. Patients with higher-risk MDS treated with hypomethylating agents (HMAs) are generally older and have a median life expectancy of 11–17 months. Patients receiving parenteral treatment for MDS spend significant time in clinics receiving HMA treatment; as such, information on the time burden of treatments (“time toxicity”) is needed to help clinicians guide patients and caregivers with alternative routes of administration. The development of oral HMA therapies offers a strategy that mitigates the time toxicity associated with MDS treatment by increasing the number of “home days” for patients. This study details the time burden among patients with MDS receiving oral HMA therapy versus those receiving intravenous and subcutaneous (IV/SC) HMAs. Methods: This was a retrospective analysis of adult patients with MDS initiating HMA therapy (oral or IV/SC HMA), using the US Cerner Enviza claims database (08/2020–08/2022). Propensity score matching (1:1) was performed on the treatment groups to balance confounding factors; matched cohorts were analyzed (N=158 each). The total direct healthcare encounter days for oral and IV/SC HMA administered patients were evaluated based on the number of healthcare encounter days spent on parenteral HMA administration (0 days for oral HMAs), outpatient, inpatient, and emergency room (ER) visits, and infusion days. Only distinct encounter days were included in the total count; multiple visits in a day were de-duplicated. Mean (SD) healthcare days for oral versus IV/SC HMA groups were calculated for each type of healthcare encounter and summarized. Results: Patients receiving oral HMA incurred a mean total of 15.2 healthcare encounter days compared with 32.8 days for those receiving IV/SC HMAs (Table). Most encounter days for the oral HMA cohort were in the outpatient setting (34.9%) while most encounters for the IV/SC HMA cohort were attributed to receiving parenteral HMA administration (55.5%), followed by inpatient (16.2%) and outpatient visits (14.9%). Conclusions: This study, which is the first report to date of time toxicity in MDS among patients treated with HMA therapy, revealed that patients receiving oral HMA incurred half the time burden of those receiving IV/SC HMAs. Further research is warranted to validate these results in a larger patient cohort and compare these findings with other cancer therapies. Healthcare encounters among patients receiving HMAs. Healthcare encounters – mean (SD) days Oral HMA (N=158) IV/SC HMAs (N=158) Parenteral administration of HMA 0 18.2 (11.4) Outpatient visits 5.3 (8.1) 4.9 (8.1) ER visits 0.3 (0.8) 0.2 (0.8) Hospital overnight stays 4.3 (9.3) 5.3 (11.9) Red blood cell transfusions 3.5 (4.4) 3.0 (4.7) Platelet transfusions 1.7 (4.6) 1.1 (3.0) Other infusions 0.1 (0.8) 0.1 (0.7) Combined encounters 15.2 (16.3) 32.8 (22.2)