Abstract
BackgroundThe goals of this multinational retrospective study were to describe treatment patterns and survival outcomes by receipt of molecular testing and molecular status of patients with advanced non-small cell lung cancer (NSCLC).MethodsThis chart review study, conducted in Italy, Spain, Germany, Australia, Japan, Korea, Taiwan, and Brazil, included 1440 patients with newly diagnosed advanced (stage IIIB/IV) NSCLC initiating systemic therapy from January 2011 through June 2013, with follow-up until July 2016. We evaluated treatment patterns and survival by histology, line of therapy, molecular testing, and test results for epidermal growth factor receptor (EGFR) mutation and/or anaplastic lymphoma kinase (ALK) rearrangement. Country-specific data were analyzed descriptively and presented as ranges (lowest to highest country). Overall survival (OS) was estimated using Kaplan-Meier method.ResultsPatients with ≥1 molecular test varied from 43% (Brazil) to 85% (Taiwan). Numerically greater proportions of patients who were female, Asian, or never/former-smokers, and those with nonsquamous histology or stage-IV NSCLC, received a test. Testing was common for nonsquamous NSCLC (54%, Brazil, to 91%, Taiwan), with positive EGFR and ALK tests from 17% (Brazil and Spain) to 67% (Taiwan) and from 0% (Brazil) to 60% (Taiwan), respectively. First-line treatment regimens for nonsquamous NSCLC with positive EGFR/ALK tests included targeted therapy for 30% (Germany) to 89% (Japan); with negative/inconclusive test results, platinum-based combinations for 88% (Japan) to 98% (Brazil); and if not tested, platinum-based combinations for 80% (Australia) to 95% (Japan), except in Taiwan, where 44% received single agents. Median OS from first-line therapy initiation was 10.0 (Japan) to 26.7 (Taiwan) months for those tested and 7.6 (Australia/Brazil) to 19.3 (Taiwan) months for those not tested.ConclusionsWe observed substantial variation among countries in testing percentages, treatment patterns, and survival outcomes. Efforts to optimize molecular testing rates should be implemented in the context of each country’s health care scenario.
Highlights
Lung cancer is the leading type of cancer and cause of cancer-related death worldwide [1,2,3]
National and international non-small cell lung cancer (NSCLC) clinical guidelines recommend that patients with advanced NSCLC testing positive for epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) rearrangement be treated with an EGFR tyrosine kinase inhibitors (TKIs) or ALK inhibitor, respectively, for first-line therapy or, alternatively, for sequential first-line or second-line therapy if mutations are discovered during the course of first-line treatment [5, 8, 9]
First-line therapy with an EGFR TKI significantly prolongs progression-free survival (PFS) and is associated with significantly higher tumor response rate when compared with first-line cytotoxic chemotherapy for patients with EGFR mutations [10]
Summary
Lung cancer is the leading type of cancer and cause of cancer-related death worldwide [1,2,3]. National and international NSCLC clinical guidelines recommend that patients with advanced NSCLC testing positive for EGFR mutation or ALK rearrangement be treated with an EGFR TKI or ALK inhibitor, respectively, for first-line therapy or, alternatively, for sequential first-line or second-line therapy if mutations are discovered during the course of first-line treatment [5, 8, 9]. Similar results were reported in recent studies of ALK inhibitor therapies (e.g., crizotinib, ceritinib, alectinib) for patients with ALK-rearranged NSCLC [11]. The goals of this multinational retrospective study were to describe treatment patterns and survival outcomes by receipt of molecular testing and molecular status of patients with advanced non-small cell lung cancer (NSCLC)
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