First-Line Systemic Treatments for Stage IV Non-Small Cell Lung Cancer in California: Patterns of Care and Outcomes in a Real-World Setting

Abstract Background Multiple systemic treatments have been developed for stage IV non-small cell lung cancer (NSCLC), but their use and effect on outcomes at the population level are unknown. This study describes the utilization of first-line systemic treatments among stage IV NSCLC patients in California and compares survival among treatment groups. Methods Data on 17 254 patients diagnosed with stage IV NSCLC from 2012 to 2014 were obtained from the California Cancer Registry. Systemic treatments were classified into six groups. The Kaplan-Meier method and multivariable Cox proportional hazards models were used to compare survival between treatment groups. Results Fifty-one percent of patients were known to have received systemic treatment. For patients with nonsquamous histology, pemetrexed regimens were the most common treatment (14.8%) followed by tyrosine kinase inhibitors (11.9%) and platinum doublets (11.5%). Few patients received pemetrexed/bevacizumab combinations (4.5%), bevacizumab combinations (3.6%), or single agents (1.7%). There was statistically significantly better overall survival for those on pemetrexed regimens (hazard ratio [HR] = 0.86, 95% confidence interval [CI] = 0.80 to 0.92), bevacizumab regimens (HR = 0.73, 95% CI = 0.65 to 0.81), pemetrexed/bevacizumab regimens (HR = 0.68, 95% CI = 0.61 to 0.76), or tyrosine kinase inhibitors (HR = 0.62, 95% CI = 0.57 to 0.67) compared with platinum doublets. The odds of receiving most systemic treatments decreased with decreasing socioeconomic status. For patients with squamous histology, platinum doublets were predominant (33.7%) and were not found to have statistically significantly different overall survival from single agents. Conclusions These population-level findings indicate low utilization of systemic treatments, survival differences between treatment groups, and evident treatment disparities by socioeconomic status.

Download Full-text

Overall survival (OS) of real-world patients with stage IIIb/IV non-small cell lung cancer (NSCLC) initiating epidermal growth factor receptor (EGFR) targeted tyrosine kinase inhibitors (TKI) as first-line treatment in England

Lung Cancer ◽

10.1016/s0169-5002(19)30138-2 ◽

2019 ◽

Vol 127 ◽

pp. S40

Author(s):

U. Rigney ◽

K. Lock ◽

C. Chen ◽

C. Escriu

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Kinase Inhibitors ◽

Growth Factor Receptor ◽

Small Cell ◽

Line Treatment ◽

Small Cell Lung ◽

First Line ◽

Epidermal Growth ◽

First Line Treatment

Download Full-text

Real-World Treatment Patterns and Survival in Stage IV Non-Small-Cell Lung Cancer in Canada

Current Oncology ◽

10.3747/co.27.6049 ◽

2020 ◽

Vol 27 (4) ◽

pp. 361-367

Author(s):

S.J. Seung ◽

M. Hurry ◽

R.N. Walton ◽

W.K. Evans

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Stage Iv ◽

Palliative Radiotherapy ◽

Treatment Patterns ◽

Small Cell ◽

Small Cell Lung ◽

First Line ◽

Stage Iv Disease ◽

Line Chemotherapy

Background: Almost half of all patients with non-small-cell lung cancer (nsclc) present with stage iv disease. The objective of the present study was to characterize treatment patterns and survival outcomes in patients with advanced nsclc. Methods: We conducted a longitudinal population-level study in patients diagnosed with stage iv nsclc in Ontario between 1 April 2010 and 31 March 2015, with follow-up to 31 March 2017 for overall survival and treatment sequence. Patients were stratified as nonsquamous or squamous histology. A sub-analysis was conducted for patients with nonsquamous histology who received targeted therapies, on the assumption that their tumours were EGFR mutation–positive (EGFRm+). Treatment patterns were determined, and survival was calculated from date of diagnosis to death or censoring. Results: Of 24,729 nsclc cases identified, stage iv disease was diagnosed in 49.2%, histology was nonsquamous in 10,103, and EGFRm+ was assumed in 508. Median patient age ranged from 69 to 72 years for the three cohorts. For patients with nonsquamous histology, palliative radiotherapy was the most frequently used first-line treatment (44.4%), followed by no treatment (26.7%) and chemotherapy (14.9%). In the EGFRm+ cohort, 75.6% received gefitinib as first- or second-line therapy, and almost half (47.4%) the 473 patients with squamous histology treated with first-line chemotherapy received cisplatin or carboplatin with gemcitabine. Median overall survival in the nonsquamous and squamous cohorts was 4.9 and 4.6 months respectively; it was 17.6 months for patients who were EGFRm+. Conclusions: Survival of patients with stage iv nsclc remains poor, with the exception of patients who are EGFRm+. Only 14.9% of patients received first-line chemotherapy; the mainstay of treatment was palliative radiotherapy.

Download Full-text

PCN183 A Cost-Effectiveness Analysis of Nivolumab plus Ipilimumab plus Two Cycles of Platinum Doublet-Chemotherapy Versus Platinum Doublet Chemotherapy in the First-Line Treatment of Stage IV or Recurrent Non-Small Cell Lung Cancer in Canada

Value in Health ◽

10.1016/j.jval.2021.04.274 ◽

2021 ◽

Vol 24 ◽

pp. S53

Author(s):

K.C. Young ◽

H. Sandhu ◽

A. Lee ◽

K. Lakhdari ◽

J. Maervoet ◽

...

Keyword(s):

Lung Cancer ◽

Stage Iv ◽

Small Cell ◽

Line Treatment ◽

Small Cell Lung ◽

First Line ◽

Effectiveness Analysis ◽

Doublet Chemotherapy ◽

First Line Treatment ◽

Platinum Doublet

Download Full-text

112P Atezolizumab as first-line therapy for patients with advanced non-small cell lung cancer: A systematic review and meta-analysis on overall survival

Journal of Thoracic Oncology ◽

10.1016/s1556-0864(21)01954-7 ◽

2021 ◽

Vol 16 (4) ◽

pp. S759

Author(s):

E. Marcella ◽

B. Susanto ◽

S. Chen ◽

J. Tandiono ◽

A. Tancherla ◽

...

Keyword(s):

Lung Cancer ◽

Systematic Review ◽

Overall Survival ◽

Small Cell Lung Cancer ◽

Meta Analysis ◽

Small Cell ◽

Small Cell Lung ◽

First Line ◽

First Line Therapy ◽

Line Therapy

Download Full-text

266 Tumour mutation burden (TMB) and efficacy outcomes in the phase III DANUBE study of advanced urothelial carcinoma (UC)

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-sitc2020.0266 ◽

2020 ◽

Vol 8 (Suppl 3) ◽

pp. A292-A292

Author(s):

Sophie Wildsmith ◽

Jill Walker ◽

Anne L’Hernault ◽

Weimin Li ◽

Hannah Bye ◽

...

Keyword(s):

Lung Cancer ◽

Stage Iv ◽

Small Cell ◽

Phase Iii ◽

Survival Outcomes ◽

Line Treatment ◽

Small Cell Lung ◽

First Line ◽

Unresectable Stage ◽

First Line Treatment

BackgroundThe phase III DANUBE study assessed the efficacy of the PD-L1 inhibitor durvalumab (D), alone or in combination with the CTLA-4 inhibitor tremelimumab (T), versus standard of care chemotherapy (SoC) for the first-line treatment of unresectable, locally advanced or metastatic UC. The study did not meet its co-primary endpoints of improving overall survival (OS) for D monotherapy vs SoC in patients with high tumor PD-L1 expression or for D+T vs SoC in the intention-to-treat population.1 TMB measurement in blood (bTMB) or tumour (tTMB) has been linked to improved efficacy with PD-1/PD-L1 inhibitors in UC and with D+T in non-small cell lung cancer,2 thus providing a rationale to explore TMB in the DANUBE trial.MethodsBaseline plasma samples from DANUBE were assessed for bTMB using the Guardant OMNI platform, while baseline tTMB was measured in formalin-fixed paraffin-embedded (FFPE) tumour samples using the FoundationOne CDx gene panel. Associations between progression-free survival (PFS) and median and landmark OS with bTMB and tTMB levels at various cutoffs were assessed as part of a pre-specified exploratory analysis. The data cutoff occurred on January 27, 2020.ResultsAmong 1032 patients randomised in DANUBE, 536 (51.9%) were evaluable for bTMB and 623 (60.4%) were evaluable for tTMB. For D vs SoC, bTMB and tTMB were not associated with OS or PFS at any cutoff. For D+T, stronger associations between bTMB and OS as well as PFS were observed with increasing bTMB cutoffs (table 1). At the bTMB cutoff ≥ 24 mut/Mb, 12-month OS rates were 76.7% for D+T and 54.3% for SoC, whereas for bTMB < 24 mut/Mb, 12-month OS rates were 53.4% for D+T and 51.2% for SoC. Similar trends for both OS and PFS were observed with tTMB (table 1).Abstract 266 Table 1Association between TMB and survival outcomes with D+TAssociation between TMB and survival outcomes with D+TConclusionsBoth bTMB and tTMB are potentially useful biomarkers for enriching responses to D+T in previously untreated, advanced UC. Neither bTMB nor tTMB was associated with better outcomes for D monotherapy. Cutoffs of 24 mut/Mb for bTMB and 10 mut/Mb for tTMB appear optimal for D+T in the setting of previously untreated, advanced UC.Trial RegistrationThe trial is registered with ClinicalTrials.gov, NCT02516241, and the EU Clinical Trials Register, EudraCT number 2015-001633-24.ReferencesAstraZeneca. Update on phase III DANUBE trial for IMFINZI and tremelimumab in unresectable, stage IV bladder cancer [press release] March 6, 2020. [https://www.astrazeneca.com/media-centre/press-releases/2020/update-on-phase-iii-danube-trial-for-imfinzi-and-tremelimumab-in-unresectable-stage-iv-bladder-cancer-06032020.html]Rizvi NA, Cho BC, Reinmuth N, et al. Durvalumab with or without tremelimumab vs standard chemotherapy in first-line treatment of metastatic non-small cell lung cancer: The MYSTIC phase 3 randomized clinical trial. JAMA Oncol. 2020:6:661–674.Ethics ApprovalThe study protocol was approved by the Ethics Board at each investigator’s institution.

Download Full-text