Treatment patterns and clinical outcomes in patients with advanced non-small cell lung cancer initiating first-line treatment in the US community oncology setting: a real-world retrospective observational study

Eric Nadler,Jie Zhou,Kathleen Marie Aguilar,Xinke Zhang,Jane Chang,Vivek Pawar,Bhakti Arondekar

doi:10.1007/s00432-020-03414-4

Abstract

PurposeTreatments for advanced non-small cell lung cancer (NSCLC) have evolved to include targeted and immuno-oncology therapies, which have demonstrated clinical benefits in clinical trials. However, few real-world studies have evaluated these treatments in the first-line setting.MethodsAdult patients with advanced NSCLC who initiated first-line treatment with chemotherapy, targeted therapies (TT), or immuno-oncology–based regimens in the US Oncology Network (USON) between March 1, 2015, and August 1, 2018, were included and followed up through February 1, 2019. Data were sourced from structured fields of USON electronic health records. Patient and treatment characteristics were assessed descriptively, with Kaplan-Meier methods used to evaluate time-to-event outcomes, including time to treatment discontinuation (TTD) and overall survival (OS). Adjusted Cox regression analyses and inverse probability of treatment weighting (IPTW) were performed to control for covariates that may have affected treatment selection and outcomes.ResultsOf 7746 patients, 75.6% received first-line systemic chemotherapy, 11.7% received immuno-oncology monotherapies, 8.5% received TT, and 4.2% received immuno-oncology combination regimens. Patients who received immuno-oncology monotherapies had the longest median TTD (3.5 months; 95% confidence interval [CI], 2.8–4.2) and OS (19.9 months; 95% CI, 16.6–24.1). On the basis of multivariable Cox regression and IPTW, immuno-oncology monotherapy was associated with reduced risk of death and treatment discontinuation relative to other treatments.ConclusionThese results suggest that real-world outcomes in this community oncology setting improved with the introduction of immuno-oncology therapies. However, clinical benefits are limited in certain subgroups and tend to be reduced compared with clinical trial observations.

Highlights

Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.The treatment landscape for advanced, unresectable, and/or metastatic non-small cell lung cancer (NSCLC) is evolving
Treatment trends and clinical outcomes reflect how current therapeutic options are being used in the community oncology setting. These results provide insight into current treatment use and outcomes associated with 1L treatment of advanced NSCLC in a real-world setting
The treatment landscape appears to be shifting in response to expanded approvals for IO therapies, a high proportion of patients still receive systemic chemotherapy, and many do not appear to advance to 2L treatment

Summary

Introduction

An analysis of the Surveillance, Epidemiology, and End Results Program (SEER) database indicated that 5-year survival rates for patients diagnosed with metastatic NSCLC increased from 2.0% (95% confidence interval [CI], 1.80–2.20%) to only 4.2% (95% CI, 4.10–4.40%) between 1988 and 2008 (Xia et al 2017). A systematic review of 8 clinical trials published between 2000 and 2008 revealed that median OS associated with doublet or triplet therapy for advanced NSCLC was 37 and 42 weeks, respectively (Azim et al 2016). Both regimens are associated with a high occurrence of adverse events (Azim et al 2009, 2016; Bittoni et al 2018)

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