(AF) Evolution of The Treatment Landscape in Patients with Advanced or Metastatic Cancers Following the Approval of Immuno-Oncology Treatments: Analysis of The England National Cancer Registry

Publication Number: 651

Background: Recent approvals of immuno-oncology (IO) treatments for several cancers were expected to substantially impact standard of care and clinical outcomes. Real-world data from patients (pts) with advanced/metastatic cancer provide evidence that is complementary to clinical trial results.

Objectives: To report the most recent treatment patterns and clinical outcomes of 4 open-ended cohorts of pts diagnosed in England with advanced/metastatic cancer for which IO agents have been approved (Merkel cell carcinoma [MCC], non-small cell lung cancer [NSCLC], renal cell carcinoma [RCC], and urothelial carcinoma [UC]) and to describe treatment landscape changes in recent years.

Methods: Cohorts were identified using routine administrative data from the National Cancer Registration and Analysis Service in England. Patient-level linkage was used to extract comprehensive national data on the disease (National Cancer Registration Dataset), inpatient, outpatient, and emergency admissions and diagnoses (Hospital Episode Statistics), anticancer radiotherapy (National Radiotherapy Dataset), and systemic anticancer treatments (Systemic Anti-Cancer Therapy Dataset). Adult pts were included following an incident primary diagnosis (index date) of stage III/IV MCC, NSCLC, RCC, or UC between Jan 2013-Dec 2019. The follow-up period was from the index date to the earliest date of death, loss to follow-up, or end of study period (Mar 2021). Overall survival (OS) was estimated by the Kaplan-Meier method.

Results: Pts comprised 583 with MCC (33.6% stage IV), 103,876 with NSCLC (68.4% stage IV), 22,379 with RCC (55.5% stage IV), and 16,610 with UC (63.1% stage IV). Systemic first-line treatments for stage III/IV disease were reported for 27.6%, 44.6%, 29.6%, and 31.3% of pts respectively. Among systemic treatment recipients, IO use was reported for 46.0% of MCC, 20.7% of NSCLC, 24.1% of RCC, and 15.1% of UC pts. Compared with an earlier data cut (diagnoses 2013-2018, followed to Dec 2019), IO use doubled in the first 3 cohorts and more than tripled in the UC cohort. Respective median OS from diagnosis of MCC, NSCLC, RCC, and UC was 18, 6.2, 24.8, and 9.8 months at this data cutoff versus 16.9, 6.2, 23.9, and 9.7 months within the earlier data.

Conclusions: This study shows considerably increased IO use and could serve as a benchmark for future real-world studies in multiple cancers, enabling clinicians to better understand the role of IO agents in clinical practice and outcomes associated with newer systemic IO agents as they become available.