Researchers presenting at AMCP Nexus 2019 recently conducted a retrospective observational study to assess patient profiles and treatment patterns among advanced non-small cell lung cancer (aNSCLC) cases. Among the study’s key findings was a high utilization of first-line systemic chemotherapy in treating aNSCLC and an increasing incidence of immuno-oncology (IO) use within in this patient population in recent years.
The treatment of aNSCLC has been significantly changed with the introduction of IO therapies. These drugs have shown optimistic outcomes and toxicity effects in clinical trials, but there is limited information regarding their treatment patterns and sequencing in U.S. community oncology environments since the emergence of IO treatments. To address this discrepancy, the study researchers analyzed data from aNSCLC patients who initiated first-line treatment with the U.S. Oncology Network (USON).
The authors for this retrospective study analyzed data regarding adult aNSCLC patients who underwent first-line treatment with systemic chemotherapy, an IO regimen, or a targeted therapy. These patients received such therapies between March 2015 and August 2018 and were followed up until February 2019. Patient data were obtained from electronic health records, with baseline characteristics and treatment patterns being assessed through description.
A total of 7,746 patients were eligible for the study, with an average age of 68 years (range, 26-90+ years; 55.0% male; 78.9% white) at the start of first-line therapy. Of those, 5,859 (75.6%) patients received systemic chemotherapy, 907 (11.7%) IO monotherapy, 656 (8.5%) TT, and 324 (4.2%) IO combination therapies as a first-line treatment. Of the patients with squamous cell carcinoma, 86.8% underwent systemic chemotherapy, 12.7% IO therapy, and only 0.6% for targeted therapy. Of the non-squamous cell carcinoma patients, 70.8% received systemic chemotherapy, 17.7% IO therapy, and 11.5% targeted therapy.
After first-line treatment, 46.7% went on to receive second-line therapy and 15.9% to a third. In the second quarter of 2015, which was the first complete quarter of the study period, the authors reported 2.1% of first-line treatments contained an IO therapy (1.7% monotherapy and 0.4% combination therapy). In the last complete quarter of the study period, the second quarter of 2018, 36.0% of first-line therapies contained an IO therapy (22.9% monotherapy and 13.1% combination therapy).
The most common sequences observed were first-line chemo followed by second-line IO (n=2,127 [27.5%]) therapy and first-line chemotherapy followed by second-line chemotherapy (n=636 [8.2%]). Otherwise, 14.2% (n=175) of the 1,231 patients who received first-line IO therapy went on to receive second-line chemotherapy, 4.0% (n=49) to IO, 2.4% (n=30) to targeted therapy, and 79.4% (n=977) did not proceed to receive further treatment during the study.
“Current treatment patterns show high utilization of 1L chemo for aNSCLC over the study period. Adoption of IO therapy is increasing, however, <40% of 1L pts treated in the U.S. community oncology setting received an IO regimen in the second quarter of 2018. Future studies should investigate outcomes associated with choice of 1L regimen and continue to evaluate the need for effective and safe IO options,” the authors concluded.
This research was sponsored by Pfizer and EMD Serono.
Nadler E, Arondekar B, et al. Treatment Patterns and Sequencing Among Patients with Advanced Non-Small Cell Lung Cancer Who Received Systemic Chemotherapy or Immuno-Oncology Regimens in the U.S. Community Oncology Setting: A Real-World Retrospective Observational Study. Presented at: AMCP Nexus 2019; October 29 – Nov 1; National Harbor, MD.