Real-world observational study of current treatment patterns and outcomes in recurrent or locally advanced/metastatic non-small cell lung cancer. (2022)

• Record Type: Journal Article
• Authors: Bazhenova, Lyudmila; Kish, Jonathan; Cai, Beilei; Caro, Nydia; Feinberg, Bruce
• Is Part Of: Cancer treatment and research communications. Number 33(2023)
• Publication Date: 2022
• Subjects: Lung cancer treatment -- Treatment trajectories -- Real-world data -- Retrospective data -- Immunotherapy
• DOI: 10.1016/j.ctarc.2022.100637
• Languages: English
• ISSNs: 2468-2942

Abstract

Highlights: This study was a retrospective, observational, physician-abstracted, multisite medical chart review of real-world patient data. The study purpose was to describe first line treatment patterns and outcomes for patients with advanced and metastatic EGFR-/ALK wild-type non-small cell lung cancer. Physicians who treated eligible patients abstracted data from medical charts into case report forms. First line treatment with immunotherapy was more prevalent in 2019 than 2016, reflecting a change in treatment paradigms. Median first line progression-free survival (PFS) did not exceed 1.5 years and median overall survival (OS) remained limited across all 1L treatment groups, illustrating the continued unmet therapeutic needs for patients with advanced/metastatic non-small cell lung cancer (NSCLC). Abstract: Background: Treatment for recurrent or advanced/metastatic non-small cell lung cancer (aNSCLC) has advanced in the past 5 years with immunotherapy (IO). This study sought to describe first-line (1L) aNSCLC treatment patterns and clinical outcomes. Methods: In this retrospective, multisite cohort study, community oncologists reported data for randomly selected stage IIIB/IV, EGFR -/ ALK wild-type aNSCLC patients who initiated 1L systemic therapy from 01/01/2016 to 12/31/2019. Follow-up was through November 2020. Demographics, clinical characteristics, treatment patterns, disease response, progression, and death/last follow-up date were described. Overall response rate (ORR) was calculated using tumor measurements applying RECIST v1.1 guidelines. Progression-free survival (PFS) and overall survival (OS) were calculated from 1L initiation by Kaplan-Meier method. Results: 497 patients from 46 sites were included. The most common 1L regimens (%) were platinum-doublet chemotherapy plus IO (PDC+IO) (40.6%), PDC (29.4%), IO monotherapy (20.7%), and PDC+bevacizumab (6.2%). From 2016 to 2019, 1L PDC declined from 63% to 10%, whereas 1L PDC+IO increased from 14% to 58%. The ORRs were 64.9%, 32.9%, 60.2%, and 61.3% for 1L PDC+IO, PDC, IO monotherapy, and PDC+bevacizumab, respectively. Median 1L PFS/OS (months) was 15.6/26.5, 5.3/13.7, 17.8/not reached, 10.8/18.6, respectively, for PDC+IO, PDC, IO monotherapy, and PDC+bevacizumab. Among patients who received only 1L treatment ( n = 299), 41.5% had no further therapy and were deceased. Conclusions: Although the 1L treatment paradigm has recently shifted to IO-based regimens, 41.5% did not survive past 1L. Median 1L PFS did not exceed 1.5 years and median OS remained limited across all 1L treatment groups, illustrating continued unmet aNSCLC therapeutic needs.