REAL-WORLD TREATMENT PATTERNS AND CLINICAL OUTCOMES IN ADVANCED/METASTATIC NON-SQUAMOUS NON-SMALL CELL LUNG CANCER WITH AND WITHOUT ACTIONABLE GENOMIC ALTERATIONS: A POPULATION-BASED COHORT STUDY IN ENGLAND, 2017-2025
Author(s)
Nelly F. Ly, PharmD, MSc1, Emily Combe, MSc1, Ateeb Khan, BSc, MBChB, PhD1, Kellyn F. Arnold, PhD2, Karabo Keapoletswe, MSc2, Chloe M. Turcan, MSc2, Panteleimon Matsakidis, MSc2, Alkesh Patel, MPharm1, Kingsley Wildman, MPharm1, Anna Minchom, MB BCh, FRCP, MD (Res)3.
1Pfizer, Tadworth, Surrey, United Kingdom, 2IQVIA, London, United Kingdom, 3Royal Marsden Hospital and The Institute of Cancer, Sutton, United Kingdom.
1Pfizer, Tadworth, Surrey, United Kingdom, 2IQVIA, London, United Kingdom, 3Royal Marsden Hospital and The Institute of Cancer, Sutton, United Kingdom.
OBJECTIVES: To describe treatment patterns and clinical outcomes among patients with advanced/metastatic non-squamous non-small cell lung cancer (NSCLC) receiving ≥2 lines of therapy (LoTs) in England.
METHODS: This retrospective cohort study identified patients with advanced/metastatic non-squamous NSCLC diagnosed between September 2017 and December 2023 in the English Cancer Registry and followed them from second-line (2L) therapy initiation to end of follow-up or latest data cut (31 August 2025). Actionable genomic alterations (AGAs) were identified from targeted treatment and/or molecular testing records. PD-L1 status was determined from molecular testing. Patient demographics and treatment patterns were described, and clinical outcomes were estimated using Kaplan-Meier methods.
RESULTS: 54,730 adults were diagnosed with unresectable stage IIIB/C or IV non-squamous NSCLC. Of these, 24,240 received first-line, 7,760 received 2L and 2,070 received third-line (3L). Among patients receiving 2L therapy, median age at diagnosis was 66 years (Q1: 58; Q3: 72), and 75% had stage IV. Among AGA-positive patients (n=2,620, 35%), 25% received EGFR inhibitors and 20% received antifolate plus platinum-based chemotherapy as 2L therapy. Among AGA-negative patients (n=5,140, 65%), the most common treatments were anti-PD-(L)1 monotherapy (45%) and antifolate plus platinum-based chemotherapy (20%) at 2L therapy, and taxane-based monotherapy (15%) or taxane-based plus VEGF/VEGFR inhibitors (30%) at 3L therapy (n=1,270). Median overall survival (OS) from 2L initiation was 10 months (95% CI, 9.6-10.3), 11.7 months (95% CI, 11.1-12.3) for AGA-positive patients, and 9.2 months (95% CI, 8.9-9.6) for AGA-negative patients. In AGA-negative patients, median OS from 2L initiation was 10.7 months (95% CI, 9.7-12.1) with high PD-L1 expression (≥50%) and 8.6 months (95% CI, 8.1-9.3) with low expression (<50%).
CONCLUSIONS: These results show a high burden of advanced/metastatic non-squamous NSCLC in England with survival remaining poor from 2L initiation overall and across subgroups, highlighting the need for novel treatments.
METHODS: This retrospective cohort study identified patients with advanced/metastatic non-squamous NSCLC diagnosed between September 2017 and December 2023 in the English Cancer Registry and followed them from second-line (2L) therapy initiation to end of follow-up or latest data cut (31 August 2025). Actionable genomic alterations (AGAs) were identified from targeted treatment and/or molecular testing records. PD-L1 status was determined from molecular testing. Patient demographics and treatment patterns were described, and clinical outcomes were estimated using Kaplan-Meier methods.
RESULTS: 54,730 adults were diagnosed with unresectable stage IIIB/C or IV non-squamous NSCLC. Of these, 24,240 received first-line, 7,760 received 2L and 2,070 received third-line (3L). Among patients receiving 2L therapy, median age at diagnosis was 66 years (Q1: 58; Q3: 72), and 75% had stage IV. Among AGA-positive patients (n=2,620, 35%), 25% received EGFR inhibitors and 20% received antifolate plus platinum-based chemotherapy as 2L therapy. Among AGA-negative patients (n=5,140, 65%), the most common treatments were anti-PD-(L)1 monotherapy (45%) and antifolate plus platinum-based chemotherapy (20%) at 2L therapy, and taxane-based monotherapy (15%) or taxane-based plus VEGF/VEGFR inhibitors (30%) at 3L therapy (n=1,270). Median overall survival (OS) from 2L initiation was 10 months (95% CI, 9.6-10.3), 11.7 months (95% CI, 11.1-12.3) for AGA-positive patients, and 9.2 months (95% CI, 8.9-9.6) for AGA-negative patients. In AGA-negative patients, median OS from 2L initiation was 10.7 months (95% CI, 9.7-12.1) with high PD-L1 expression (≥50%) and 8.6 months (95% CI, 8.1-9.3) with low expression (<50%).
CONCLUSIONS: These results show a high burden of advanced/metastatic non-squamous NSCLC in England with survival remaining poor from 2L initiation overall and across subgroups, highlighting the need for novel treatments.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO165
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment, Relating Intermediate to Long-term Outcomes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology