Abstract
PurposeTo establish a baseline for care and overall survival (OS) based upon contemporary first-line treatments prescribed in the era before the introduction of immune checkpoint inhibitors, for people with metastatic non-small cell lung cancer (NSCLC) without common actionable mutations.MethodsUsing a nationally representative electronic health record data from the Flatiron dataset which included 162 practices from different regions in US, we identified patients (≥18 years old) newly diagnosed with stage IV NSCLC initiating first-line anticancer therapy (November 2012- January 2015, with follow-up through July 2015). Patients with documented epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) translocation were excluded. Anti-cancer drug therapy and overall survival were described overall, and by histology.ResultsA total of 2,014 patients with stage IV NSCLC without known EGFR or ALK genomic tumor aberrations initiated systemic anticancer therapy, 22% with squamous and 78% with nonsquamous histology. Their mean (SD) age was 67 (10) years, 55% were male, and 87% had a smoking history. In nonsquamous NSCLC, carboplatin plus pemetrexed either without (25.7%) or with bevacizumab (16%) were the most common regimens; 26.6% of nonsquamous patients receiving induction therapy also received continuation maintenance therapy. In squamous NSCLC, carboplatin plus paclitaxel (37.6%) or nab-paclitaxel (21.1%) were the most commonly used regimens. Overall median OS was 9.7 months (95% CI: 9.1, 10.3), 8.5 months (95% CI: 7.4, 10.0) for squamous, and 10.0 months (95% CI: 9.4, 10.8) for nonsquamous NSCLC.ConclusionThe results provide context for evaluating the effect of shifting treatment patterns of NSCLC treatments on patient outcomes, and for community oncology benchmarking initiatives.
Highlights
Lung cancer is the leading cause of cancer-related deaths in the United States (US) and worldwide: 221,200 new cases and 158,000 deaths from lung cancer were projected for 2015 in the US alone [1]
The final study population comprised the 2,014 patients who had documented first-line chemotherapy initiated from November 1, 2012, through January 31, 2015, including 436 (22%) with squamous and 1,578 (78%) with nonsquamous Non-small cell lung cancer (NSCLC)
Summary
Lung cancer is the leading cause of cancer-related deaths in the United States (US) and worldwide: 221,200 new cases and 158,000 deaths from lung cancer were projected for 2015 in the US alone [1]. The recommendations for systemic anticancer therapy for stage IV NSCLC vary according to tumor histology, the patient’s performance status, and driver oncogene biomarker status, most frequently epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) translocation [4,5,6,7]. Patients deemed candidates for systemic therapy who have stage IV NSCLC without an activating EGFR mutation or ALK translocation, representing approximately 85% of cases; guidelines recommend first-line (induction) therapy with a platinum-based doublet chemotherapy regimen using a carboplatin or cisplatin doublet. One or more of the agents used in first-line induction therapy can be continued (continuation maintenance), or patients can be switched to a new agent (switch maintenance). The NCCN guidelines recommend bevacizumab and pemetrexed (alone or in combination) or gemcitabine for continuation maintenance and pemetrexed or erlotinib for switch maintenance. The NCCN guidelines recommend bevacizumab and pemetrexed (alone or in combination) or gemcitabine for continuation maintenance and pemetrexed or erlotinib for switch maintenance. [4,5]
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