412P - Treatment patterns and selection criteria for advanced non-small cell lung cancer (NSCLC) patients unfit for platinum-based first-line therapy: Results of the MOON-OSS observational trial

Background

A significant proportion of newly diagnosed advanced NSCLC patients does not receive a first-line platinum doublet due to unfavorable clinical characteristics.

Methods

We retrospectively collected data on 221 EGFR/ALK negative and PD-L1 <50% patients [median age 79 (range 56-92) years, M/F 165(74.6%)/56(25.4%), PS 0/1/≥2 23(10.4%)/94(42.5%)/103(47.1%), adenoK/squamous/large-cell/NOS 107(48.4%)/94(42.5%)/9(4.1%)/11(5%), median of 2 serious comorbidities] with stage IIIB-IV NSCLC treated with a first-line single agent. Clinicians were asked about the criteria according to which treatment selection was made and what percentage of patients did not receive a first-line platinum-based chemotherapy.

Results

A median of 25% (range 10%-30%) of newly diagnosed NSCLC did not receive a first-line platinum combination. The main clinical criteria according to which decision was made were older age (76.5%), comorbidities (72%), low PS (55.2%) and familiar or social issues (10%). Single-agent treatment consisted of gemcitabine (Gem 10%), oral standard vinorelbine (Vin 8.2%), oral metronomic vinorelbine (MetV 78.6%) and other (O 3.2%). Median time-to-progression (TTP) and overall survival (OS) of single agent treatments were Gem 4.5, Vin 4.5, MetV 5, O 5 months and Gem 9, Vin 9, MetV 10, O 10.5 months respectively. Overall grade 3-4 toxicities were lower with MetV (8%) than with Gem (13.6%), Vin (16.6%) and O (14.3%). Median TTP and OS without grade 3-4 toxicity were Gem 5, Vin 4.5, MetV 6.5, O 5.5 months and Gem 10, Vin 10, MetV 12, O 12 months respectively. Dose delays (Gem 41%, Vin 16.6%, MetV 13.8%, O 28.6%) and dose reductions (Gem 31.8%, Vin 33.3%, MetV 17.8%, O 28.6%) were less frequent with MetV.

Conclusions

We confirmed that up to 30% of newly diagnosed advanced EGFR/ALK negative and PD-L1 <50% NSCLC patients do not receive a first-line platinum doublet. Main clinical selection criteria were older age (>70years), comorbidities and low (≥2) PS. An oral treatment was frequently proposed with MetV being the preferred alternative chosen by clinicians due to the excellent safety profile.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.