2066 - Second-line (2L) real-world treatment (tx) patterns and outcomes in patients (pts) with advanced/metastatic non-small cell lung cancer (NSCLC) treated with first line (1L) immuno-oncology (IO) monotherapy (mono tx)

Background

1L IO mono tx for advanced NSCLC is an option based on recent clinical trials. As there are few data regarding tx sequencing following 1L IO mono tx for NSCLC, there is interest in seeking evidence to identify optimal tx sequences in this setting. This analysis explored 2L systemic tx and overall survival (OS) in pts with NSCLC following 1L IO mono tx in a real-world setting.

Methods

A retrospective analysis of 2604 randomly selected pts with advanced (stage IIIB/IV) NSCLC treated in US practices (156 community and 3 academic sites) between Jan 2013 and Dec 2018 was conducted using the Flatiron Health EHR-derived database. Tx regimens were defined using only therapies initiated in the first 30 days of tx. 1L tx was defined as tx received prior to disease progression (PD); 2L tx was defined as first tx after first PD. 2L tx patterns and OS were assessed in pts treated with 1L IO mono tx. OS and 95% CIs were calculated using Kaplan-Meier (KM) methods.

Results

Pts treated with 1L IO mono tx (initiated after 01 Jan 2016) at each site were identified in the database (N = 105). 91 pts were eligible for the initial exploratory analysis (platinum-based doublet/triplet, n = 35; single-agent chemo, n = 26; IO ± chemo, n = 15; other, n = 15; Table). A multivariable-adjusted KM analysis of 2L OS revealed longer survival with platinum-based doublet/triplet (24.4 months) vs IO ± chemo (17.9 months), other (11.6 months), and single-agent chemo (4.7 months).Table:

1497P Adjusted 2L OS in pts treated with 1L IO mono Tx

NE, not estimable.

Includes targeted mono tx/doublets, chemo/monoclonal antibody doublets, chemo doublets, and clinical study drugs.

Conclusions

Although the longest survival was in the platinum-based cohort, the unknown tx strategy for 1L IO mono tx and a small sample size limit the generalizability of the data. The hypothesis-generating result suggests further research on the efficacy of 2L platinum therapy after 1L IO tx is needed. Additional analyses of complementary real-world data in an NSCLC population treated with IO in the 1L are planned.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Celgene.

Disclosure

S.M. Fish: Full / Part-time employment: Celgene. T. Jin Ong: Full / Part-time employment: Celgene. E.D. Flick: Full / Part-time employment: Celgene. D.M. Waterhouse: Advisory / Consultancy: AbbVie; Advisory / Consultancy: Amgen; Advisory / Consultancy: AZ; Advisory / Consultancy: BMS. All other authors have declared no conflicts of interest.