Author of

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  P2.01 - Advanced NSCLC (ID 159)

  • Event: WCLC 2019
  • Type: Poster Viewing in the Exhibit Hall
  • Track: Advanced NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall

  • 30684

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    P2.01-75 - Temporal Trends in Treatment Patterns for Advanced/Metastatic Non-Small Cell Lung Cancer (aNSCLC) in Routine Clinical Practice (ID 2714)

    10:15 - 18:15  |  Presenting Author(s): Victoria J Stefaniak
    • Abstract
    • Slides

    Background
    

    For aNSCLC patients lacking actionable molecular markers, guideline recommendations for first-line treatment include platinum-based chemotherapy or immune checkpoint inhibitors (ICIs) as single agents or in combination with platinum-based chemotherapy (platinum-based chemoimmunotherapy) based on recent clinical trials and FDA approvals. When initial therapy fails, recommendations are for second-line treatment with ICIs (if not given in first-line), single-agent chemotherapy, or ramucirumab+docetaxel. The objective of this study was to understand the evolution of aNSCLC treatment patterns following the May 2017 FDA approval of platinum-based chemoimmunotherapy in frontline.

    Method
    

    This retrospective observational study analyzed electronic health record data from the Flatiron Health database for adult patients who initiated first-line therapy for aNSCLC between 01/01/2015-12/31/2018. Eligible patients were stratified by first-line treatment initiation time period (before and after May 2017).

    Result
    

    Of the 22,342 eligible patients receiving first-line treatment, 9,482 (42%) initiated second-line systemic therapy, and of those, 3,260 (34%) initiated third-line therapy during the study period. Patient characteristics were generally consistent over time. Overall, there was considerable heterogeneity in the treatment landscape for aNSCLC, with over 200 unique regimens used in each of the three treatment lines evaluated. After May 2017, platinum-based regimens continued to be the standard treatment in first-line (Table), with increasing usage of ICIs as single agents (mostly pembrolizumab) or in combination with platinum-based chemotherapy (mostly pembrolizumab+pemetrexed+platinum), and decreasing use of platinum-based regimens that do not contain an ICI. In second-line, use of ICI monotherapy was consistent and usage of single-agent chemotherapy decreased slightly after May 2017. The use of platinum-based chemotherapy in second-line increased after May 2017, consistent with increased usage among patients receiving first-line ICI monotherapy. Overall, second-line ramucirumab+docetaxel usage increased as ramucirumab+docetaxel has become the most commonly used regimen following first-line platinum-based chemoimmunotherapy. In third-line, the use of ICI monotherapy decreased after May 2017 while usage of single-agent chemotherapy remained consistent over time. Third-line ramucirumab+docetaxel usage also increased after May 2017, in line with increased use of third-line ramucirumab+docetaxel among patients previously treated with sequential platinum-based chemotherapy and ICI monotherapy in first- and second-line.

    Conclusion
    

    This study illustrates the changing treatment landscape for aNSCLC in real-world clinical practice since May 2017. While usage of aNSCLC treatments continues to be highly variable, the approval and rapid uptake of ICIs in frontline appears to have altered how available post-progression treatment options are prescribed and sequenced. Future studies should evaluate the impact of these changes and treatment heterogeneity on patient outcomes.

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