OBJECTIVES: Non-small cell lung cancer (NSCLC) is a prevalent cancer worldwide, with treatment efficacy varying according to driver mutations. However, there is a gap regarding the real-world effectiveness associated with NSCLC patients who do not receive targeted therapy or experience first-line treatment failure. This study aims to examine treatment patterns for advanced NSCLC patients and evaluate the costs related to not receiving targeted therapy and experiencing first-line treatment failure.

METHODS: A comprehensive analysis was conducted using data from the Taiwan Cancer Registry, National Health Insurance claim data and Cause of Death in 2014-2020. The study included 28,497 advanced or metastatic patients with NSCLC who underwent first-line therapy. Among them, 6,449 patients (22.63%) without driver mutations experienced failure of first-line treatment. Primary endpoints included time to next treatment (TTNT) and overall survival (OS), with secondary outcomes focused on medical utilization after second-line therapy.

RESULTS: Approximately 75.4% of NSCLC patients received first-line therapy, 50.5% receiving tyrosine kinase inhibitors (TKI) and 47.6% having EGFR mutations+. Among patients receiving second-line therapy, 48.6% underwent mono-chemotherapy, while 26.1% received TKI therapy. The median OS during second-line therapy was 6.9 months (IQR: 2.89-14.96) and the median TTNT was 3.4 months (IQR: 1.58-7.00). One-year survival rate during second-line therapy were 7.1% for TKIs and 8.8% for platinum-based therapy. The healthcare cost revealed that patients receiving second-line immunotherapy had the highest total medical costs (US$7,696 per patient per month), while those undergoing platinum-based third-line chemotherapy had the highest costs (US$5,356 per patient per month).

CONCLUSIONS: In advanced NSCLC, TKIs were the predominant choice for first-line therapy, while chemo-monotherapy was commonly employed in the second-line setting. Immunotherapy as both first- and second-line therapies was associated with the highest total medical costs. These findings offer valuable insights into treatment patterns and cost implications in advanced NSCLC, informing clinical decision-making and resource allocation.