A better understanding of real-world treatment (tx) patterns and associated clinical outcomes in the rapidly changing landscape of NSCLC is critical for informing clinical decision-making and maximising pt benefits. The SCAN-LEAF project aims to describe epidemiology, clinical care and outcomes of NSCLC pts in Scandinavia. Here, we report tx patterns and outcomes in pts with incident stage IIIB-IV NSCLC in 2 university hospitals in Sweden.
This retrospective cohort study includes all adult pts diagnosed with stage IIIB-IV NSCLC from 2012–2015, and followed in Uppsala and Stockholm University hospitals (follow-up until end of 2016). Electronic medical records were extracted and linked with national registries. Lines of therapy (LoTs) were defined using an algorithm based on systemic anticancer therapy (SACT). Descriptive results are shown by histology. Ongoing analyses will assess LoTs by mutation status, time to next LoT and overall survival using the Kaplan–Meier method.
1625 pts diagnosed at stage IIIB-IV were identified (58.5% of all incident NSCLC). Mean age was 69.1 yrs (13.6% ≥80 yrs) and 49.5% were male. Histology distribution was: 70.9% non-squamous cell carcinoma (NSQ), 17.7% squamous-cell carcinoma (SQ), 10.3% not otherwise specified (NOS) and 3.4% other NSCLC. Of 831 EGFR-tested pts (51.1%), 21.2% had mutant EGFR; of 612 ALK-tested pts (37.7%), 10.0% had ALK translocations; of 33 PD-L1-tested pts (2.0%), 45.5% had PD-L1 expression ≥1%. Overall, 888 pts (54.7%) received a 1st LoT, of whom, 276 received a 2nd LoT (31.1%). SACT regimens are shown in the table.Table: 1484P
|SACT regimens in stage IIIB-IV NSCLC (used in ≥ 5 patients)||All NSCLC||NSQ||SQ||NOS|
|1st line of therapy, %||(N = 888)||(N = 638)||(N = 119)||(N = 99)|
|Non-platinum single agent||5.2||4.4||6.7||6.1|
|Tyrosine kinase inhibitor (mainly erlotinib)||14.4||18.0||5.0||6.1|
|2nd line of therapy, %||(N = 276)||(N = 201)||(N = 40)||(N = 24)|
|Non-platinum single agent||56.5||55.7||62.5||66.7|
|Tyrosine kinase inhibitor||19.6||24.4||5.0||8.3|
During the 2012-2016 period (mainly prior to immunotherapy reimbursement), approximately half of incident stage IIIB-IV pts received a 1st LoT and only one-third of those received a 2nd LoT, mostly with non-platinum chemotherapy or tyrosine kinase inhibitors. Almost half of stage IIIB-IV NSCLC pts remained untreated after diagnosis (no SACT regimen).
Clinical trial identification
Legal entity responsible for the study
S. Ekman: Grants: Bristol-Myers Squibb, during the conduct of the study. P. Horvat, D. Layton, J. Kim, M. Rosenlund: Employee: IQVIA. A. Juarez-Garcia: Employee: Bristol-Myers Squibb. H.C. Jacobs: Personal fees: Bristol-Myers Squibb, during the conduct of the study. L. Lacoin: Consultant epidemiologist contracted: Bristol-Myers Squibb for the SCAN-LEAF project. All other authors have declared no conflicts of interest.