OBJECTIVES: Treatment (Tx) decisions for metastatic NSCLC are complex. Our aim is to describe results of a physician survey (CancerMPact^®) from WE in 2020, focusing on first-line (1L) and maintenance (1L MT) Tx of stage IV NSCLC without driver mutations.

METHODS: Physicians (N=103) were recruited online. Responding physicians reported proportions of Tx used among patients they treat with stage IV NSCLC without driver mutations by histology (squamous [SQ] and non-squamous [NSQ]) and line of therapy. Results were aggregated across France, Germany, Italy, Spain, and the United Kingdom (WE).

RESULTS: The most common regimens in 1L were pembrolizumab plus carboplatin plus pemetrexed for NSQ NSCLC patients with PD-L1 negative or unknown expression and PD-L1 1-49% (17.9%, 30.9% of patients, respectively), and pembrolizumab monotherapy (50.9%) for PD-L1 >50%. Among SQ NSCLC patients, common 1L regimens were carboplatin plus paclitaxel (20.4% of patients) for PD-L1 negative or unknown, pembrolizumab plus carboplatin plus paclitaxel (27.2%) for PD-L1 1-49%, and pembrolizumab monotherapy (49.9%) for PD-L1 >50%.

The top 1L MT regimens were pembrolizumab (29.0% of patients), pembrolizumab plus pemetrexed (20.5%), and bevacizumab (19.8%) in NSQ, and pembrolizumab (88.9%) and pemetrexed (3.6%) in SQ patients. For NSQ patients who received pembrolizumab plus platinum plus pemetrexed in 1L, the physicians reported using pembrolizumab monotherapy (38.5%) and pembrolizumab plus pemetrexed (30.7%) in 1L MT compared with pemetrexed monotherapy (28.7%) and pembrolizumab monotherapy (20.0%) among those who received platinum plus pemetrexed in 1L. SQ NSCLC patients with platinum doublet in 1L most commonly received pembrolizumab monotherapy (46.9%) in 1L MT.

CONCLUSIONS: Pembrolizumab and platinum doublets were reported as the most common 1L Tx in WE. Pembrolizumab was the most common 1L MT for both NSQ and SQ patients. Variability in Tx and MT regimens suggests that there is no clear standard of care for these patients.