(92) Using Real-World Data to Examine Treatment Patterns of Patients with Advanced Non-Small Cell Lung Cancer Treated with Systemic Therapies

Publication Number: 766

Background: Advanced non-small cell lung cancer (aNSCLC) is common. Current, comprehensive real-world (RW) data are needed due to the rapidly changing treatment landscape.

Objectives: Describe first- (1L), second- (2L), or third line (3L) aNSCLC treatment regimens, time-to-treatment (TTT), and treatment duration.

Methods: In this retrospective cohort study, 27,4691 US patients (age ≥18 years) with an incident diagnosis of lung cancer (index date) between 01/2016–05/2021 were identified from Komodo healthcare claims data; 16,427 were classified as aNSCLC by metastatic diagnosis ≤1 month pre- and ≤3 months post-index and aNSCLC treatment ≤3 months post-index. Patients were followed until the earliest of health plan disenrollment or 11/2021. All patients had ≥6 months follow-up, no other primary malignant neoplasms, and no small-cell lung cancer-specific treatment. 1L treatment was defined as first systemic treatment after diagnosis excluding therapies ≤90 days of surgery. A line of therapy was defined as agents prescribed ≤30 days of starting the line. End of treatment line was assumed if gap in drug availability >45 days. Treatment duration was assessed with Kaplan-Meier statistics, including 95% confidence intervals (CI).

Results: Median age was 63 years (range 18-89); 49% were male. Payer type (multiple were possible) included commercial (40.9%), Medicaid (18.6%), Medicare (27.6%), and other (33.3%). 16,122 (98.1%) received 1L systemic treatment, 7,251 (44.1%) 2L, and 2,090 (12.7%) 3L. Median follow-up was 14.7 months. Most common regimens by line included carboplatin + paclitaxel (1L: 25%), durvalumab (2L: 21%), and gemcitabine (3L: 12%). Immunotherapy was used in 60.8% of all patients (1L: 34.7%, 2L: 55.5%, 3L: 33.9%). Targeted therapies, including ALK- and EGFR inhibitors, were used in 12.4% of patients (1L: 10.2%, 2L: 8.4%, 3L: 8.7%). Median TTT was 1.3 months. Median 1L duration was 2.14 months (95% CI 2.10-2.24), median 2.20 months (95% CI 2.07-2.30) for 2L, and median 1.64 months (95% CI 1.55-1.84) for 3L. 3.1% of patients received treatment beyond 3L.

Conclusions: Platinum-based chemotherapy was the most common regimen in 1L, immunotherapy most common in 2L, and chemotherapy most common in 3L aNSCLC therapy. This study leverages a large claims database and results are consistent with other RW studies.