Treatment Patterns for Advanced Non–Small-cell Lung Cancer After Platinum-containing Therapy in U.S. Community Oncology Clinical Practice

• Published in: Clinical lung cancer 2016-09, Vol.17 (5), p.449-460.e7
• Main Authors: McKay, Caroline, Burke, Thomas, Cao, Xiting, Abernethy, Amy P., Carbone, David P.
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biomarker testing; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - pathology; Female; Flatiron Health; Humans; Line of therapy; Lung Neoplasms - drug therapy; Lung Neoplasms - pathology; Male; Middle Aged; Mutation; NSCLC; Platinum Compounds - administration & dosage; Real-world treatment patterns; Receptor Protein-Tyrosine Kinases - genetics; Receptor, Epidermal Growth Factor - genetics; Retrospective Studies; Time Factors; Translocation, Genetic; Treatment Outcome; United States
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2016.03.008

The present retrospective observational study included 1173 patients with advanced non–small-cell lung cancer (72% nonsquamous, 23% squamous, and 5% not otherwise specified). After first-line platinum-containing therapy (and tyrosine kinase inhibitor, as appropriate), 94 different regimens were administered, illustrating the diversity of second-line regimens for non–small-cell lung cancer in the community oncology setting. Docetaxel was the most common, prescribed to 14% of the patients. Knowledge of the real-world treatment patterns for non–small-cell lung cancer (NSCLC) can identify quality-of-care gaps and guide resource allocation needs. Our objective was to describe the treatment patterns for advanced NSCLC after first-line chemotherapy in the era before the approval of immunotherapeutic agents. The present was a retrospective observational study of adult patients with advanced NSCLC (stage IIIB/IV or metastatic recurrence) who had completed a platinum-containing regimen, with an appropriate tyrosine kinase inhibitor if positive for epidermal growth factor receptor mutation or anaplastic lymphoma kinase translocation. Eligible patients initiated second-line chemotherapy from November 2012 through October 2014, recorded in an oncology record system for U.S. community clinics. Of 6867 patients with advanced NSCLC, 4188 (61%) initiated and 2707 (39%) completed platinum therapy, with a tyrosine kinase inhibitor, if appropriate. Subsequently 1889 of 2707 (70%) received second-line chemotherapy, including 1173 within the study period (844 [72%] nonsquamous, 275 [23%] squamous, and 54 [5%] not otherwise specified). The mean ± standard deviation patient age was 66 ± 10 years; 54% were male. Of the 94 different second-line regimens, docetaxel was the most common, prescribed to 14% of the patients overall and 14% and 16% of the nonsquamous and squamous cohorts, respectively. The median duration was 64 days (range, 1-455 days) and 48 days (range, 1-210 days) for the nonsquamous and squamous cohorts, respectively. The median duration by regimen category was 15 to 85 days (overall range, 1-953 days). These findings show the diversity, short treatment duration, and lack of efficacy of second-line chemotherapy regimens for NSCLC in the community oncology setting.