Real-World Treatment Patterns Among Adult Patients with Advanced Non-Small Cell Lung Cancer in the US

OBJECTIVES: With the rapid evolution of the treatment landscape for non-small cell lung cancer (NSCLC), this study aims to assess the real-world treatment patterns and shed light on how quickly new guidelines are integrated into clinical practice.

METHODS: A descriptive cohort study was conducted using electronic health records from a national NSCLC registry. Adult patients who initiated lung cancer treatment following diagnosis of advanced NSCLC (stage IIIB/IIIC/IV) from 01/01/2015-12/31/2021 were identified. Baseline characteristics and treatment patterns were described; continuous variables as mean and standard deviation (SD) and categorical variables as proportions.

RESULTS: 8,768 patients met inclusion criteria. The mean age was 66.7 (SD=±10.0) years; 52.7% were male; 65.9% having non-squamous cell carcinoma; 22.4% having squamous cell carcinoma; 11.7% unknown. 13.4% of patients were receiving care from academic centers, 78.7% from community hospitals, 8.0% for whom care site was unknown. The five most common first-line therapies (LoT1), accounting for 66.0% of all LoT1, were carboplatin + pembrolizumab + pemetrexed, carboplatin + paclitaxel, pembrolizumab, carboplatin + pemetrexed, and carboplatin + paclitaxel + pembrolizumab. 51.6% of all patients received second line of therapy (LoT2); the five most common LoT2, representing 45.2% of LoT2 were nivolumab, durvalumab, pembrolizumab, docetaxel + ramucirumab, and carboplatin + paclitaxel. Among 26.4% of patients receiving third-line therapy (LoT3), the five most common, accounting for 38.1% of LoT3, were nivolumab, docetaxel, docetaxel + ramucirumab, osimertinib, and pembrolizumab. There were 22 patients with documentation of NSCLC with no identified guideline recommended line of therapy.

CONCLUSIONS: Traditional platinum-based chemotherapy was the most common regimen in LoT1, while immune check point inhibitor (ICI) monotherapy and ICI combinations were the most common therapy in LoT2 and LoT3. The growing use of ICIs indicated that new evidence was rapidly adopted among NSCLC patients. While most treatments align with current guidelines, instances of nonadherence were observed.