e19139 Background: Non-small cell lung cancer (NSCLC) is the leading cause of cancer death in the US, with a 5-year survival rate of < 20%. Treatment patterns and outcomes in late stage NSCLC in US community oncology practices are not well known. Methods: This retrospective study used the iKnowMed database, billing claims, and chart reviews. Eligibility criteria included non-squamous NSCLC, stage IIIB/IV at diagnosis, ECOG status <3, and initiation of second-line therapy (defined as index date) between 1/1/2007-6/30/2011 with > 1 year follow-up. Key outcomes were overall survival (OS), progression-free survival (PFS), time-to-progression (TTP), and time-to-hospitalization (from index date). Progression was defined as change in therapy and/or new metastatic lesion. Kaplan-Meier and Cox proportional hazard models were used to characterize the distribution and predictors of outcomes. Results: 1,168 patients were eligible for the study. The top three second-line therapies were pemetrexed (54.4%), erlotinib-containing regimens (17.6%), and docetaxel (10.0%). OS and PFS were 7.5 (95% CI: 6.6-8.4) and 4.1 (95% CI: 3.7-4.5) months, respectively; 57% of patients were hospitalized post-index date. EGFR testing rates were 2.3% pre-2010, 15.2% in 2010, and 32.0% in the studied 2011 period (p<0.001). Of EGFR-positive patients, 50.0% received erlotinib-containing regimens compared to 16.9% of EGFR-negative patients (p=0.001). Baseline ECOG=1 (HR=1.49; p<0.001) or ECOG=2 (HR=1.79; p<0.001), compared to ECOG=0, existing co-morbid fatigue (HR=1.53; p=0.010) compared to no co-morbid fatigue, and progression (HR=1.78; p<0.001), when it occurred, compared to no progression, increased risk of shorter time to hospitalization, adjusting for other factors. Compared to other second-line treatment, erlotinib-containing regimens prolonged adjusted TTP (HR=0.68; p=0.018). Conclusions: EGFR testing in community practice rose rapidly after 2010 suggesting improved personalized treatment given study evidence that EGFR inhibitors prolonged adjusted TTP. Also, ECOG ≥1 and progression, once it occurred, predicted shorter time-to-hospitalization.
Cost-Effectiveness In The Second-Line Treatment Of Non-Small Cell Lung Cancer (Nsclc) In The Us
