First-line treatment patterns in advanced NSCLC in western Europe (EU), the United States, and Japan including a comparative analysis of younger versus elderly patients

Abstract

8053 Background: The latest developments in advanced NSCLC are represented by targeted therapy (TT), treatment decisions based on tumor histology, and biomarker research. A patient (pt) case-based survey was conducted in three regions to study current pt characteristics and treatment patterns. Methods: 629 physicians treating stage III/IV NSCLC provided details on up to 10 of their pts. Results: Overall, 3455 EU pts, 895 US pts, and 600 Japanese pts were monitored. This analysis focuses on the 89% of pts with stage IIIb/IV NSCLC. In each region, median age, gender, and occurrence of malignant pleural effusion were comparable but tumor histology differed slightly. Comparative analyses revealed that monotherapy (MT) with either chemotherapy (CT) or TT agents is used significantly more in elderly pts (≥70 yrs) while combination therapy (CT/TT doublets or triplets) is more frequent in younger pts. This is consistent across all regions and histologies (squamous vs non-squamous). In the EU, 48.3% of elderly and 13.6% of younger pts received MT (39.9% vs 15.1% for US pts, 32.0% vs 9.4% for Japanese pts). CT/TT doublets were used predominantly in younger vs elderly pts (72.3% vs 48.1% in the EU, 47.3% vs 36.9% in the US, and 81.7% vs 65.5% in Japan). Triplets were also more widely used in younger vs elderly pts (14.3% vs 3.6% in the EU, 36.3% vs 22.6% in the US, and 6.5% vs 1.8% in Japan). For both age groups, the leading MTs are erlotinib in the EU and US, and gefitinib in Japan but use is higher in elderly pts. Preferred doublets in the EU are platinum+gemcitabine (28.8%), platinum+vinorelbine (13.6%) and platinum+taxanes (13.5%). Platinum+taxanes is predominant in the US and Japan (27.7% and 55.4%, respectively). The triplets, bevacizumab+platinum+taxanes (27.0%) and bevacizumab+platinum+other (3.5%), are also common in the US while these treatments only represent 5.1% and 3.9%, respectively, in the EU. Conclusions: Important regional differences in 1st-line advanced NSCLC treatment exist with triplets being more common in the US only. MT is more frequent in elderly pts and combination therapy is more common in younger pts. This latter finding is consistent across all regions and histological subsets. [Table: see text]