COMPARISON OF PATIENT CHARACTERISTICS AND FIRST-LINE TREATMENT PATTERNS IN METASTATIC NSCLC: US AND FINLAND COHORTS TO INFORM OVERALL SURVIVAL TRANSPORTABILITY ANALYSES
Author(s)
Per-Olof Thuresson, MSc1, Philani Mpofu, PhD2, Johanna Vikkula, MSc3, Mohamed S. Ali, PharmD, SM2, Harlan Pittell, PhD2, Aija Knuuttila, MD4, Riikka Mattila, PhD3.
1Roche, Basel, Switzerland, 2Flatiron Health, New York, NY, USA, 3Medaffcon, Helsinki, Finland, 4HUS, Helsinki University Hospital, Helsinki, Finland.
1Roche, Basel, Switzerland, 2Flatiron Health, New York, NY, USA, 3Medaffcon, Helsinki, Finland, 4HUS, Helsinki University Hospital, Helsinki, Finland.
OBJECTIVES: To characterize baseline patient characteristics and first-line (1L) treatment patterns in metastatic non-small cell lung cancer (mNSCLC) across the United States (US) and Finland, informing a subsequent cross-country overall survival transportability analysis.
METHODS: Retrospective descriptive analysis using the EHR-derived, Flatiron Health Research Database and Finnish HUS CORE dataset. Eligible patients had mNSCLC diagnosed between 2015-2025 and initiated 1L treatment outside a clinical trial. First-line treatment distributions, temporal trends, and treatment sequences through the third line were described. Baseline characteristics were compared using standardized mean differences (SMDs; |SMD|>0.10 = meaningful imbalance).
RESULTS: The analysis included 47,338 (US) and 1,180 (Finland) patients. Several characteristics at diagnosis were broadly balanced: age at 1L initiation (US: 68.8 vs. Finland: 67.9 years; SMD=0.08), sex (49.8% vs. 50.7%; SMD=0.02), histology (78.6% vs. 81.3% non-squamous; SMD=0.07), and smoking history (83.3% vs. 81.6%; SMD<0.10); de novo metastatic disease was an exception (76.8% vs. 86.1%; SMD=0.22). ECOG PS at 1L initiation was imbalanced (SMD=0.57), attributable to differential data capture rather than clinical differences (unknown ECOG: 17.1% US vs. 42.1% Finland). First-line treatment distributions differed (SMD=0.40): platinum-based chemotherapy predominated in Finland (49.0% vs. 29.8%), while ICI-based regimens were more prevalent in the US (ICI monotherapy: 19.0% vs. 9.1%; ICI+chemotherapy: 30.2% vs. 16.3%); targeted therapy was comparable (17.2% vs. 20.8%). ICI adoption increased in parallel, with Finland lagging approximately 2 years, consistent with regulatory and reimbursement timelines. Among 1L patients, 38.4% (n=453) in Finland and 44.0% (n=20,811) in the US initiated 2L treatment; the most common 1L→2L transitions were PT-CT→ICI in the US (20.6%) and PT-CT→non-platinum chemotherapy in Finland (24.1%).
CONCLUSIONS: Demographic and clinical characteristics were broadly comparable between US and Finnish mNSCLC populations. Observed treatment landscape differences, particularly higher ICI uptake in the US, likely reflect regulatory and reimbursement timing rather than fundamental population differences, informing interpretation of cross-country survival comparisons.
METHODS: Retrospective descriptive analysis using the EHR-derived, Flatiron Health Research Database and Finnish HUS CORE dataset. Eligible patients had mNSCLC diagnosed between 2015-2025 and initiated 1L treatment outside a clinical trial. First-line treatment distributions, temporal trends, and treatment sequences through the third line were described. Baseline characteristics were compared using standardized mean differences (SMDs; |SMD|>0.10 = meaningful imbalance).
RESULTS: The analysis included 47,338 (US) and 1,180 (Finland) patients. Several characteristics at diagnosis were broadly balanced: age at 1L initiation (US: 68.8 vs. Finland: 67.9 years; SMD=0.08), sex (49.8% vs. 50.7%; SMD=0.02), histology (78.6% vs. 81.3% non-squamous; SMD=0.07), and smoking history (83.3% vs. 81.6%; SMD<0.10); de novo metastatic disease was an exception (76.8% vs. 86.1%; SMD=0.22). ECOG PS at 1L initiation was imbalanced (SMD=0.57), attributable to differential data capture rather than clinical differences (unknown ECOG: 17.1% US vs. 42.1% Finland). First-line treatment distributions differed (SMD=0.40): platinum-based chemotherapy predominated in Finland (49.0% vs. 29.8%), while ICI-based regimens were more prevalent in the US (ICI monotherapy: 19.0% vs. 9.1%; ICI+chemotherapy: 30.2% vs. 16.3%); targeted therapy was comparable (17.2% vs. 20.8%). ICI adoption increased in parallel, with Finland lagging approximately 2 years, consistent with regulatory and reimbursement timelines. Among 1L patients, 38.4% (n=453) in Finland and 44.0% (n=20,811) in the US initiated 2L treatment; the most common 1L→2L transitions were PT-CT→ICI in the US (20.6%) and PT-CT→non-platinum chemotherapy in Finland (24.1%).
CONCLUSIONS: Demographic and clinical characteristics were broadly comparable between US and Finnish mNSCLC populations. Observed treatment landscape differences, particularly higher ICI uptake in the US, likely reflect regulatory and reimbursement timing rather than fundamental population differences, informing interpretation of cross-country survival comparisons.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
SA30
Topic
Study Approaches
Topic Subcategory
Meta-Analysis & Indirect Comparisons, Registries
Disease
Oncology