A Registry-Based Study of Patterns of Use of Targeted Therapies for Metastatic Cancers in Diverse Populations

/Abstract One of the most important cancer care advances in recent history is the rapid dissemination of targeted and immunotherapies into the care of patients with metastatic cancer. The marked expansion of indications for use of these novel therapies has been fueled by growing enthusiasm among medical oncologists regarding their potential impact on survival for patients with very poor prognosis. Although the survival benefit of these therapies is modest for most patients, a small proportion experience long-term remission and potentially even cure of previously incurable cancer. Despite the exciting promise of these therapies, they are very expensive – sometimes exceeding $10,000 per month. Because of the high cost and high stakes of these therapies, it is critical to understand their patterns of use; yet very little is known about targeted therapy use across diverse populations. Moreover, the impact of clinician factors on variations in use is not known. In the absence of such knowledge it is difficult to develop effective interventions to support equitable delivery of these therapies. Guidelines for the use of targeted and immunotherapies in cancer care have continued to evolve rapidly since our parent study was funded. Most notably, there have been marked changes in the treatment paradigm of metastatic gastrointestinal (GI) cancers with rapid expansion in indications for use of immunotherapies and, to a lesser extent, targeted therapies. Comprised of multiple primary cancer types—colorectal, pancreatic, gastric and esophageal, hepatobiliary—GI malignancies are on the rise and are often diagnosed late in the disease course when they are already metastatic and incurable. Importantly, these patients were excluded from our parent study because at the time of our original submission targeted and immunotherapies were only rarely used for GI cancers outside of clinical trials. Now we propose to incorporate these patients and their treating oncology clinicians into our study and examine their treatment experiences. We have been working together with our SEER registry partners to ascertain receipt of targeted and immunotherapies directly from oncology clinicians for our parent study sample. However, this approach is both labor intensive and time consuming. Therefore, innovative methods to automate the collection of treatment data and allow scalability across cancer types and across SEER registries are urgently needed. We now propose a logical extension of our parent study to 1) expand the study cohort to include 1000 patients diagnosed with metastatic GI cancers and their treating oncology clinicians, and 2) incorporate innovative natural language processing (NLP) methodologies to automate the extraction of data about specific treatments and in-tumor molecular alterations from existing free text fields in the SEER registry data. Taken together with the contributions of our parent study, our findings will lay the groundwork for future population-based research of cancer care delivery and outcomes among diverse patients with metastatic cancers, inform interventions, and advance population science across SEER program regional registries. Project Number: 4R37CA251464-06 | Fiscal Year: 2026 | NIH Institute/Center: National Cancer Institute (NCI) | Principal Investigator: Christine Veenstra | Institution: UNIVERSITY OF MICHIGAN AT ANN ARBOR, ANN ARBOR, MI | Award Amount: $334,735 | Activity Code: R37 View on NIH RePORTER: https://reporter.nih.gov/project-details/11128083