Year of Publication


Degree Name

Master of Science (MS)

Document Type

Master's Thesis




Pharmaceutical Sciences

First Advisor

Dr. Val R. Adams


Background/Rationale: Studies have shown antiresorptive agents decrease skeletal related events in metastatic non-small cell lung cancer. However, two prevalence studies have found low utilization rates of antiresorptive therapy in advanced lung cancer. The first study reported a rate of 14.8% during the 1995-2009 time period, while the second study reported a 33% usage rate during the time frame of 2002-2011. We believe these low utilization rates are associated with the poor prognosis of these patients. The prognosis of advanced lung cancer has improved significantly since these trials were conducted, and the utilization of denosumab has not been evaluated. We hypothesize that intravenous antiresportive bone therapies are underutilized in patients with metastatic lung cancer.

Objectives: To characterize the utilization of antiresportive therapies in patients with metastatic lung cancer and to evaluate predictive factors in their initiation.

Methods: This study was a retrospective analysis of EHR data from the University of Kentucky Enterprise Data Warehouse (UKEDW) linked to Kentucky Cancer Registry (KCR) containing patients from 1/1/2013 to 1/31/2020. Patients diagnosed with metastatic lung cancer are included with “index date” being date of first systemic treatment. Key exclusion criteria included lack of systemic therapy provided at UK. Incidence of antiresorptive bone therapy initiation was measured. Descriptive statistics and multivariate logistic regressions were performed to assess factors predicting use and selection of agent.

Results: Over the study time period, only 16.3 % of patients who received their first systemic therapy at UK were initiated on an antiresorptive bone medication, with denosumab being the primary agent used (~65%). Logistic regression analysis shows that patients with bone metastasis present at diagnosis of stage IV NSCLC had 4.26 times the odds of receiving an antiresorptive bone medication (95% [CI: 2.146,8.442]) than those who did not have bone metastasis at diagnosis.

Conclusions: For metastatic non-small cell lung cancer patients receiving their first systemic therapy at the University of Kentucky, antiresorptive bone therapies are being underutilized with the primary predictor of use as bone metastasis at diagnosis.

Digital Object Identifier (DOI)

Funding Information

This research was partially funded by the American Foundation For Pharmaceutical Education (AFPE) Gateway 2019-2020 Fellowship