OBJECTIVES: First-line treatment for patients with NSCLC and PD-L1 ≥ 50% has evolved to include several immunotherapies. The objective of this study was to analyse treatment patterns in a Danish real-world setting.

METHODS: Data from May 15, 2018 to February 28, 2023 were collected from the Danish National Hospital Medication Register, the National Patient Register, and the Danish Pathology Register. Treatment patterns were analysed in patients with non-squamous or squamous NSCLC and PD-L1 ≥ 50%, who had received at least one administration of first-line mono-immunotherapy. Due to incomplete reporting to the Danish National Hospital Medication Register, the study cohort only included patients treated in the Capital Region of Denmark, the Zealand Region, and the Central Denmark Region. Coverage compared to the National Patient Register was about 80%.

RESULTS: The study cohort comprised of 463 patients of which 75% had non-squamous histology and 25% had squamous histology. Patients were distributed evenly across the regions. The share of new non-squamous NSCLC patients treated with pembrolizumab decreased from 100% in the third quarter of 2021 to 14.3% in the first quarter of 2023, while the share treated with atezolizumab increased from 0% to 85.7%. In this period, the average time between administrations decreased for pembrolizumab and increased for atezolizumab, indicating a shift from treatment every 6 weeks (Q6W) to Q3W and Q3W to Q4W, respectively. The average dose per administration changed accordingly. Mean treatment length was less than 1 year for both therapies. The Central Denmark Region was the main driver of the changes observed, being the first region to initiate treatment with atezolizumab and introduce changes to the dose regimens. Overall, a similar pattern in treatment shares was observed in the squamous population.

CONCLUSIONS: The treatment patterns showed adherence to Danish guidelines with the fastest adaptation observed in the Central Denmark Region.