First-line systemic therapy in metastatic non-small cell lung cancer (mNSCLC) patients treated at National Comprehensive Cancer Network (NCCN) institutions: An analysis from the NCCN Oncology Outcomes Database Project.

Abstract

7634 Background: The NCCN Clinical Practice Guidelines (GL) allow many systemic therapy options for patients (pts) with mNSCLC. The primary aims of this analysis were to identify first-line regimens for the treatment of mNSCLC pts and examine concordance with NCCN NSCLC GL. Methods: The database was queried to identify pts with mNSCLC treated with first-line systemic therapy at 8 NCCN institutions presenting between September 2006 and March 2009. Pt characteristics, regimens utilized, and GL concordance were analyzed. Systemic therapy was categorized as cytotoxic doublet (CD), combination cytotoxic/targeted therapy (C/T), targeted therapy alone (T), or cytotoxic single agent (SA). Results: A total of 983 eligible pts were identified, as follows: 51% male; median age 64 years; performance status (PS) was documented in 77% (82% PS 0 or 1; 11% PS 2; 7% PS 3 or 4). There were 729 pts (74%) treated with systemic therapy, 123 (17%) of which participated in a clinical trial. Most common reasons for not receiving therapy were death prior to treatment (37%), therapy was not recommended (35%), or unknown (20%). For PS 3 or 4 pts not enrolled in a clinical trial, 20/48 (42%) received systemic therapy. Systemic therapy administered: 437 CD (60%), 139 C/T (19%), 94 T (13%), and 46 SA (6%). A platin-agent was used in 96% of CDs, with carboplatin in 83%. Paclitaxel (45%), gemcitabine (22%), docetaxel (15%) and pemetrexed (9%) were the most common partner agents. Of 600 pts with adenocarcinoma, 50 (8%) were treated with pemetrexed. Bevacizumab with carboplatin and either paclitaxel or docetaxel were the most common C/Ts (85% of C/T, 16% of all treated). Erlotinib was the most common T (92% of T, 12% of all treated). Analyses of EGFR mutation testing and concordance to NCCN NSCLC GLs are underway. Conclusions: The majority of pts with mNSCLC were treated with first-line systemic therapy and 17% participated in a clinical trial. Though not included in the NCCN GL prior to 2010, treatment of PS 3 or 4 pts and first-line therapy including erlotinib were observed. Few pts with adenocarcinoma received pemetrexed in the first-line setting. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration ImClone Systems, Merck Genentech, Lilly Abbott Laboratories, Abraxis BioScience, Genentech, Lilly, Pfizer