OBJECTIVES

In Sweden, ICIs have been reimbursed since 2015 for locally advanced/metastatic NSCLC. ICI monotherapy has been used as second-line (2L) treatment for squamous carcinoma (SQ) since December 2015, for non-squamous carcinoma (NSQ) since June 2016, and as first-line (1L) treatment for high programmed death-ligand-1 (PD-L1) expressors (≥50%) since March 2017. This study from the SCAN LEAF project, part of the I-O Optimise initiative, assessed the early use of ICIs for the real-world management of advanced/metastatic NSCLC.

METHODS

This retrospective cohort study included adult patients without ALK rearrangements/EGFR mutations diagnosed with advanced/metastatic NSCLC at Karolinska University Hospital between January 2012-December 2017 (follow-up: December 2018) who started a 1L treatment. Electronic medical records data were linked to national registries data. Index date was the treatment initiation date. Patient characteristics and treatment patterns are described by histology, period (pre-IO: 2012-2014; washout: 2015-2016; early post-IO: 2017-2018), and systemic anticancer therapy (SACT) regimen.

RESULTS

In 2012-2018, 1485 patients received a 1L SACT (NSQ/other, 1217; SQ, 268). Median (IQR) age was 69.7 (63.6-74.5) years at 1L treatment start. Between 2012-2014 and 2017-2018, PD-L1 testing prior to 1L start increased from <1% to 32% for NSQ/other and 0% to 40.4% for SQ. Overall, 89.4% NSQ/other and 90.3% SQ patients received 1L platinum-based chemotherapy. 47.7% of all patients died during/after receiving 1L treatment; 13.6% were censored; 38.7% received 2L therapy. In the NSQ/other cohort, an ICI was received by 1.1% (mostly 3L+) of patients in the pre-IO and 18.2% (3.0% 1L, 13.4% 2L, 1.8% 3L+) in the early post-IO period. In the SQ cohort, these values were 3.4% (3L+) and 23.1% (7.7% 1L; 13.5% 2L; 1.9% 3L+).

CONCLUSIONS

In the early post-IO period, ~one-fifth of patients with advanced/metastatic NSCLC treated at Karolinska University Hospital received an ICI, mainly in 2L setting. Future studies will evaluate the impact of ICIs on outcomes.