Abstract 112P
Background
Treatment approaches for stages I–III NSCLC are rapidly evolving due to recent regulatory approvals of EGFR-targeted therapy and immunotherapy, increasing the importance of understanding real-world treatment patterns in US community practices. This observational study aimed to describe patient characteristics and primary treatments pre-2020 and from 2020–2022.
Methods
The Syapse Learning Health Network of patients with cancer who receive care in US community health systems was queried for adults with stage I-III NSCLC with no historical primary cancer within 5 years, and minimum 10 months potential follow-up from NSCLC diagnosis. Two cohorts were compared descriptively by time period of initial NSCLC diagnosis: 2015–2019 (cohort 1) and 2020–2022 (cohort 2), overall and by NSCLC stage.
Results
In both cohort 1 (N=5503) and cohort 2 (N=2963), median age was 70 years; 52% were women; 82–83% were White; and 92% were current/former smokers. NSCLC stages in cohorts 1/2 were 45%/47% at stage I; 16%/16% at stage II; and 39%/38% at stage III. Overall, 40%/43% of patients had surgical primary treatment (Table), most commonly for stage I (54%/59%) or stage II NSCLC (53%/51%) vs. stage III (20%/20%). Among those with surgery, neoadjuvant (± adjuvant) therapy use was only 6%/5% overall; surgery + adjuvant therapy use was 23%/24% overall (Table) and increased with NSCLC stage (6%/6% at stage I; 51%/58% at stage II; 53%/64% at stage III). Of stage III patients, 59%/61% received nonsurgical treatments, most commonly with chemoradiation (67%/68%).
Table: 112P
Primary treatments for stages I-III NSCLC by time period
| Cohort 1, N=5503 (2015–2019 diagnosis) | Cohort 2, N=2963 (2020–2022 diagnosis) | |
| Surgical primary treatment, n (%) | 2216 (40) | 1270 (43) |
| Surgery only | 1567 (71) | 901 (71) |
| Neoadjuvant ± adjuvant therapy | 138 (6) | 60 (5) |
| Surgery + adjuvant therapy | 511 (23) | 309 (24) |
| Nonsurgical primary treatment, n (%) | 2207 (40) | 1191 (40) |
| Definitive chemoradiation only | 992 (45) | 542 (46) |
| Definitive radiotherapy only | 823 (37) | 470 (39) |
| Systemic therapy only | 392 (18) | 179 (15) |
| No treatment identified, n (%) | 1080 (20) | 500 (17) |
Conclusions
No major changes in primary treatments were evident in community practice for patients with stage I–III NSCLC from pre-2020 to the 2020–2022 period. Among surgical approaches, neoadjuvant and adjuvant therapy use was low, although adjuvant therapy rates were greater for stages II and III NSCLC. Nonsurgical approaches remained most common for stage III NSCLC, particularly chemoradiation.
Editorial acknowledgement
Medical writing and editorial assistance were provided by Elizabeth V. Hillyer, DVM (freelance).
Legal entity responsible for the study
Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.
Funding
This work was supported by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.
Disclosure
J.S. Donington: Financial Interests, Personal, Speaker’s Bureau: AstraZeneca, Merck, BMS, Roche/Genentech; Financial Interests, Personal, Advisory Board: AstraZeneca, Merck, BMS, Roche/Genentech. X. Hu, Y. Kao, A. Arunachalam, D.R. Chirovsky, A. Samkari: Financial Interests, Personal, Full or part-time Employment: Merck; Financial Interests, Personal, Stocks/Shares: Merck. K. Kane, C. Zhang: Financial Interests, Personal, Full or part-time Employment: Syapse Holdings; Financial Interests, Personal, Stocks/Shares: Syapse Holdings.