Molecular testing and treatment patterns for patients with advanced non-small cell lung cancer: PIvOTAL observational study

• Published in: PloS one 2018-08, Vol.13 (8), p.e0202865-e0202865
• Main Authors: Lee, Dae Ho, Tsao, Ming-Sound, Kambartel, Karl-Otto, Isobe, Hiroshi, Huang, Ming-Shyan, Barrios, Carlos H, Khattak, Adnan, de Marinis, Filippo, Kothari, Smita, Arunachalam, Ashwini, Cao, Xiting, Burke, Thomas, Valladares, Amparo, de Castro, Javier
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Asia; Australia; Biology and Life Sciences; Biomarkers; Biomarkers, Tumor - genetics; Brazil; Cancer; Cancer patients; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - pathology; Care and treatment; Chemotherapy; Clinical outcomes; Data processing; Epidermal growth factor; Epidermal growth factor receptors; Europe; Female; Genetic Testing; Growth factors; Health aspects; Health care; Histology; Hospitals; Humans; Lung cancer; Lung diseases; Lung Neoplasms - drug therapy; Lung Neoplasms - pathology; Lymphoma; Male; Medicine and Health Sciences; Middle Aged; Molecular diagnostic techniques; Mutation; Non-small cell lung cancer; Non-small cell lung carcinoma; Observational studies; Outcome and process assessment (Medical care); Patients; People and Places; Platinum; Practice Patterns, Physicians; Prognosis; Protein-tyrosine kinase; Retrospective Studies; Smoking; Studies; Survival; Survival Rate; Therapy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0202865

The goals of this multinational retrospective study were to describe treatment patterns and survival outcomes by receipt of molecular testing and molecular status of patients with advanced non-small cell lung cancer (NSCLC). This chart review study, conducted in Italy, Spain, Germany, Australia, Japan, Korea, Taiwan, and Brazil, included 1440 patients with newly diagnosed advanced (stage IIIB/IV) NSCLC initiating systemic therapy from January 2011 through June 2013, with follow-up until July 2016. We evaluated treatment patterns and survival by histology, line of therapy, molecular testing, and test results for epidermal growth factor receptor (EGFR) mutation and/or anaplastic lymphoma kinase (ALK) rearrangement. Country-specific data were analyzed descriptively and presented as ranges (lowest to highest country). Overall survival (OS) was estimated using Kaplan-Meier method. Patients with ≥1 molecular test varied from 43% (Brazil) to 85% (Taiwan). Numerically greater proportions of patients who were female, Asian, or never/former-smokers, and those with nonsquamous histology or stage-IV NSCLC, received a test. Testing was common for nonsquamous NSCLC (54%, Brazil, to 91%, Taiwan), with positive EGFR and ALK tests from 17% (Brazil and Spain) to 67% (Taiwan) and from 0% (Brazil) to 60% (Taiwan), respectively. First-line treatment regimens for nonsquamous NSCLC with positive EGFR/ALK tests included targeted therapy for 30% (Germany) to 89% (Japan); with negative/inconclusive test results, platinum-based combinations for 88% (Japan) to 98% (Brazil); and if not tested, platinum-based combinations for 80% (Australia) to 95% (Japan), except in Taiwan, where 44% received single agents. Median OS from first-line therapy initiation was 10.0 (Japan) to 26.7 (Taiwan) months for those tested and 7.6 (Australia/Brazil) to 19.3 (Taiwan) months for those not tested. We observed substantial variation among countries in testing percentages, treatment patterns, and survival outcomes. Efforts to optimize molecular testing rates should be implemented in the context of each country's health care scenario.