P10.07 Real-World US Treatment Patterns and Clinical Outcomes in Advanced NSCLC After Prior Platinum Chemotherapy and Immunotherapy

Abstract

Immune checkpoint inhibitor (ICI) therapy and platinum-based doublet chemotherapy (PDC), combined or sequentially, are the standard of care for treatment-naive patients with metastatic non-small cell lung cancer (NSCLC) without targetable driver mutations. Upon failure of these, there is a lack of data on physicians’ treatment choices in this setting and their real-world effectiveness. This retrospective, observational study evaluated real-world treatment patterns and outcomes within US community oncology settings in this recently emerged post-ICI/PDC patient population. This study used the nationwide electronic health record (EHR)-derived de-identified Flatiron Health NSCLC database. Patients included were ≥18 years of age, diagnosed with advanced/metastatic NSCLC between January 1, 2015 and February 29, 2020. Patients were required to have had previous treatment for their advanced disease with ICI and PDC, either combined in first line (1L) or sequentially in 1L and second line (2L), and to have received treatment post-ICI/PDC. Patients were excluded if they had evidence of EGFR or ALK alterations. Patient characteristics and treatment patterns were assessed. Overall survival (OS) was estimated using Kaplan–Meier analyses and was defined as the time from the initiation of subsequent treatment following ICI and PDC until death (event) from any cause or patient censoring on the last date of activity in the Flatiron database due to lack of an event, whichever occurred first. Additional analyses by subgroups, such as histological subtype and previous ICI/PCD treatment sequence, were also conducted. Among the 2294 patients who met the study eligibility criteria, their median age was 66 years (range: 59-73), 43.0% (n=987) were female, and 93.0% (n=2134) were treated in community-based settings. Most patients (63.2%, n=1449) had received 1L PDC followed by 2L ICI, 29.6% (n=680) 1L ICI plus PDC, and 7.2% (n=165) received 1L ICI followed by 2L PDC. Of the total sample, 29.0% (n=674) of patients received regimens containing docetaxel, mainly in combination with ramucirumab (15.0%, n=344), or as monotherapy (11.0%, n=251). The median OS was 7.29 months (95% CI, 6.90-7.66) in the overall population, 6.47 months (95% CI, 5.59-7.56) with docetaxel plus ramucirumab, and 6.74 months (95% CI, 5.65-8.48) with docetaxel monotherapy. This study reports real-world treatment patterns and survival outcomes in patients with advanced/metastatic NSCLC post-ICI/PDC. These real-world results from EHRs for patients primarily treated in community settings indicate a high unmet need for new therapies that could potentially improve outcomes in patients with advanced/metastatic NSCLC post-ICI/PDC.