Retrospective Analysis of Real-World Treatment Patterns and Clinical Outcomes in Patients With Advanced Non-Small Cell Lung Cancer Starting First-Line Systemic Therapy in the United Kingdom

Abstract

Background: The treatment landscape for advanced non-small cell lung cancer (aNSCLC) has evolved rapidly since immuno-oncology (IO) therapies were introduced. This study used recent data to assess real-world treatment patterns and clinical outcomes in aNSCLC in the United Kingdom. Methods: Electronic prescribing records of treatment-naive patients starting first-line (1L) treatment for aNSCLC between June 2016 and March 2018 (follow-up until December 2018) in the United Kingdom were assessed retrospectively. Patient characteristics and treatment patterns were analyzed descriptively. Outcomes assessed included overall survival (OS), time to treatment discontinuation, time to next treatment, and real-world tumor response.Results: In all, 1003 patients were evaluated (median age, 68 years [range, 28-93 years]; 53.9% male). Use of 1L IO monotherapy (0%-25.9%) and targeted therapy (11.8%-15.9%) increased during the study period, but chemotherapy remained the most common 1L treatment at all time points (88.2%-58.2%). Median OS was 9.5 months (95% CI, 8.8-10.7 months) for all patients, 8.1 months (95% CI, 7.4-8.9 months) with chemotherapy, 14.0 months (95% CI, 10.7-20.6 months) with IO monotherapy, and 20.2 months (95% CI, 16.0-30.5 months) with targeted therapy. In the 28.6% of patients who received second-line treatment, IO monotherapy was the most common drug class (used in 51.6%).Conclusions: Although use of 1L IO monotherapy for aNSCLC increased in the United Kingdom during the study period, most patients received 1L chemotherapy. An OS benefit for first-line IO monotherapy vs chemotherapy was observed but was numerically smaller than that reported in clinical trials. Targeted therapy was associated with the longest OS, highlighting the need for improved treatment options for tumors lacking targetable mutations.

Characterizing the Shifting Real-World Treatment Landscape by PD-L1 Testing Status and Expression Level in Advanced Non-Small Cell Lung Cancer

“…Published studies evaluating treatment patterns for aNSCLC describe a shift in treatment modalities that supports rapid acceptance and clinical uptake of ICIs immediately following their approval and incorporation into guidelines [13][14][15][16][17]. The current study showed that these shifts to ICIs have been maintained.…”

“…Characterizing the treatment landscape advances our understanding of how these therapies are used in real-world clinical settings, and could potentially inform management strategies to enhance patient outcomes. While several studies have reported patterns of firstline treatment for aNSCLC subsequent to ICI approval [13][14][15][16][17], these studies did not stratify by PD-L1 expression level and covered only the initial years after the introduction of ICIs and thus may not reflect contemporary management of patients with aNSCLC. Therefore, the objective of this study was to describe the treatment landscape and trends among patients with aNSCLC initiating first-line treatment across PD-L1 expression levels and those not undergoing PD-L1 testing.…”

Cancer treatment patterns and factors affecting receipt of treatment in older adults: results from the ASPREE Cancer Treatment Substudy (ACTS)

“…A frequency of cytotoxic chemotherapy use in patients with metastatic lung cancer receiving systemic therapy follows previously published data from Australia, 31 the US, 20 and the United Kingdom. 32 Our older cohort, however, received less systemic therapy (50%) for advanced lung cancer when compared to younger cohorts; for example, Ngo et al reported receipt of systemic therapy in 76% and 65% of patients aged <60 and 60-69 years, respectively. 31 While only six ACTS participants (8%) received immunotherapy compared to 12% of similar patients in the US, 20 it should be noted that immunotherapy was not routinely used during the ASPREE time period (pre-2017).…”