Real-World Outcomes in Patients with Resected Non-Small Cell Lung Cancer (NSCLC) Receiving (NEO)Adjuvant Treatment in Germany: An I-O Optimise Analysis
Author(s)
Baltus H1, Waldmann A1, Leal C2, Saglimbene V3, Schoemaker MJ4, Evans-Cheung T5, Rault C6, Daumont M7, Emanuel G8, Lucherini S9, Vo L10, Penrod JR10, Katalinic A1
1University of Luebeck, Luebeck, Germany, 2IQVIA, Porto Salvo, Portugal, 3IQVIA, Florence, Italy, 4IQVIA, Amsterdam, Netherlands, 5IQVIA, London, UK, 6DataGnosis, Rennes, France, 7Global Health Economics and Outcomes Research - Europe, Bristol-Myers Squibb, Brussels, Belgium, 8Bristol Myers Squibb, Uxbridge, UK, 9Bristol Myers Squibb, London, CHE, UK, 10Bristol Myers Squibb, Princeton, NJ, USA
Presentation Documents
OBJECTIVES: The cornerstone of treatment for patients with non-metastatic NSCLC is surgery; however, questions remain on the relative benefits of (neo)adjuvant systemic anti-cancer therapy (SACT) in these patients. We describe initial treatment for patients with non-metastatic (stage IB-IIIA) NSCLC in Germany and factors associated with overall survival (OS) among patients receiving (neo)adjuvant SACT+/-radiotherapy (RT), before the availability of recently approved immunotherapy in (neo)adjuvant settings.
METHODS: This registry-based cohort study included data from the Versorgungsforschung in der Oncology database (VONKOdb) of adult patients with resectable stage IB-IIIA NSCLC (UICC 7th/8th edition) diagnosed between January 2016-December 2019 (minimum 6 months of follow-up). OS was described using Kaplan-Meier method; multivariate analyses were performed using Cox regression.
RESULTS: Of 11,364 patients with stage IB-IIIA NSCLC, 6022 (53.0%) were resected. Of these, 63.3% underwent surgery alone, 4.5% received surgery + neoadjuvant SACT+/-RT, 0.3% received surgery + neoadjuvant RT, 1.1% received surgery + peri-operative SACT, 28.5% received surgery + adjuvant SACT+/-RT, and 2.6% received surgery + adjuvant RT.
In patients receiving SACT+/-RT, median OS (IQR) with neoadjuvant cisplatin vs carboplatin was 57.8 [14.5-not reached; NR] vs 37.2 months [11.3-60.9] and NR [25.5-NR] vs 47.6 months [22.4-NR]) with adjuvant cisplatin vs carboplatin. Among patients receiving adjuvant SACT+/-RT, factors significantly associated with worse prognosis in multivariate analysis were: older age (vs 65-74 years), tumor stages T3 and T4 (vs T1), node stages N1 and N2 (vs N0), male sex (vs female) and adjuvant RT (vs no RT). In patients receiving neoadjuvant SACT+/-RT, only neoadjuvant RT was significantly associated with worse prognosis.CONCLUSIONS: These real-world data show that, in the pre-immunotherapy era, most resected patients with non-metastatic NSCLC received surgery alone or with adjuvant SACT+/-RT, whereas neoadjuvant SACT+/-RT use was rare. Among patients receiving (neo)adjuvant SACT+/-RT, survival outcomes were better with no additional RT although this may be due to confounding by indication.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Code
EPH82
Disease
Oncology, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)