OBJECTIVES : Recent studies highlighted considerable delay in time from approval to first purchase of innovative cancer treatments in Italy. This study investigates within-country geographic differences across Italian regions, by examining treatment patterns in the first two lines of therapy (1L-2L) in metastatic NSCLC (mNSCLC) and RCC (mRCC), between January 2019 and May 2021.

METHODS : Patients with a mNSCLC/mRCC diagnosis (Stage IIIA/B-IV) who received at least one line of systemic therapy were identified from OffTheShelf™, a large retrospective database of patient charts collected from Italian oncologists. For each patient, the type of systemic therapy received (immunotherapies [IOs], chemotherapy, targeted therapy, others), the line of therapy and the Italian region and macro-region (North=N, Center=C, South=S, Islands=I) of care were extracted and analyzed.

RESULTS : In the mNSCLC cohort (1L n=4,358 , 2L n= 2,816), the use of 1L IOs varied largely, (50.8% in Tuscany(C); 15.1% in Calabria(S) and Molise(S)). 1L chemotherapy was the dominant therapeutic approach across most regions, except Apulia(S). Use of 2L IOs was higher than chemotherapy across all regions, except Calabria(S), with marked differences remaining across regions (>80% 2L IO use in Apulia(S), Liguria(N) and Molise(S); <60% in Calabria(S) and Emilia-Romagna(N)). In the mRCC 1L cohort (n=6,187) use of IOs remained very low (<10%), except in Emilia-Romagna(N) and Valle D’Aosta(N), and TKIs represented dominant therapeutic approach across all regions. The majority of 2L patients (n=3,984) were on IOs except in Calabria(S) and Basilicata(S). The use of IOs was greatest at 83.7% in Marche(C), Puglia(S) and Veneto(N) (77.5% and 69.5%). A distinct pattern of IOs use when comparing Italians macro-regions was not observed in either indication.

CONCLUSIONS : Contemporary and granular real-world evidence on mNSCLC/mRCC treatment landscape in Italy shows that 1L-2L systemic therapy treatment patterns in mNSCLC and mRCC remain heterogeneous across regions, and does not align with macro-regions, but potentially with centers of excellence.