3926 - Impact of second-line (2L) immune checkpoint inhibitors (ICIs) on the treatment (Tx) of advanced non-small cell lung cancer (NSCLC) in a UK centre: a REAL-Oncology analysis from the I-O Optimise initiative

Background

The benefits of ICIs for patients (pts) with NSCLC have been shown in several clinical trials, but real-world data are limited. We describe the early impact of 2L ICI Tx on clinical practice at the Leeds Cancer Centre (LCC), a UK site of I-O Optimise, a multinational research platform providing insights into real-world lung cancer management.

Methods

This retrospective cohort study used longitudinal data from electronic medical records of adults diagnosed with advanced NSCLC (stage IIIB/IV) between Jan 2013 and Oct 2018 (2-month minimum follow-up). Pts with EGFR or ALK mutations were excluded from the analysis due to different Tx patterns expected in this population eligible for targeted Tx. Pre- and post-ICI sub-cohorts were defined by date of first 2L ICI use at LCC (Mar 2016). Distinct lines of Tx were identified using a clinically verified algorithm based on date of prescribed systemic anti-cancer therapy (SACT) and time between prescriptions. Age and ECOG performance score (PS) at time of initial diagnosis were recorded.

Results

Of 1196 pts with advanced NSCLC during the study period, 409 (34.2%) received SACT; (annual rates were 33.5–38.1%). In all, 103 pts (8.6%) received 2L Tx, of which 26 (25.2%) had EGFR/ALK mutations; of the remaining 77 pts without EGFR/ALK mutations, 29 were treated pre-ICI and 48 post-ICI. In the pre-ICI sub-cohort, median age was 65.0 yrs and 82.8% had an ECOG PS < 2; 13 pts (44.8%) received a tyrosine kinase inhibitor, 6 (20.7%) had non-platinum SACT, and most remaining pts had platinum SACT. All had platinum SACT as first-line (1L) Tx. In the post-ICI sub-cohort, median age was 67.0 yrs and 77.1% had an ECOG PS < 2; 26 pts (54.2%) received an ICI (pembrolizumab, nivolumab, or avelumab), 10 (20.8%) had platinum SACT, and 7 (14.6%) had non-platinum SACT. Almost all pts (89.6%) had platinum SACT as 1L Tx, with the rest receiving an ICI. Early outcomes and 2L duration in pre- and post-ICI sub-cohorts will be presented.

Conclusions

Two years on from the introduction of ICIs as a 2L option in UK clinical practice, their use is well established among eligible pts, but overall 2L SACT Tx remains very low. The impact on survival will be presented.

Clinical trial identification

Editorial acknowledgement

Richard Daniel, PhD and Kate Bradford, PhD of PAREXEL, funded by Bristol-Myers Squibb.

Legal entity responsible for the study

Bristol-Myers Squibb.

Funding

Bristol-Myers Squibb.

Disclosure

M. Snee: Research grant / Funding (institution), I am a paid consultant to IQVIA. My employer Leeds teaching hospitals NHS trust has received a grant from IQVIA: IQVIA. L. Lacoin: Advisory / Consultancy, Consultant for BMS: Bristol-Myers Squibb. W. Sopwith: Full / Part-time employment, I am employed by IQVIA to work on this project: IQVIA. C. Chaib: Full / Part-time employment, Employee: Bristol-Myers Squibb. J.R. Penrod: Shareholder / Stockholder / Stock options, Full / Part-time employment: Bristol-Myers Squibb. J.C. O’Donnell: Shareholder / Stockholder / Stock options, Full / Part-time employment: Bristol-Myers Squibb. All other authors have declared no conflicts of interest.