There is limited data on the prevalence, rate of mutations, and patterns of treatment in a “real-world” setting in Brazil. The aim of this retrospective observational study was to evaluate the above-mentioned aspects from the private health system’s perspective in the country. METHODS:

Data from 44 HMOs on all patients with metastatic NSCLC receiving any line of treatment between September 2013 - September 2014 using Evidências-Kantar Health private market administrative claims database was analyzed. After patient de-identification, information on demographics, diagnosis, and treatment regimens and duration was collected. Prevalence of patients in each treatment line was calculated by the number of existing cases of a disease by the total population with lung cancer at one year. RESULTS:

We identified 273 lung cancer patients of which 182 patients (66.7%) had metastatic NSCLC, and were thus eligible for analysis. The most frequent histology type was adenocarcinoma (71%) followed by squamous cell carcinoma (12%). The majority (81%) was not tested for any mutation. Among the tested patients (n=35), 1 patient was ALK+ and 17 were EGFR+. The only ALK+ patient received a second line treatment with carboplatin+pemetrexed. Of the 17 patients with EGFR mutation, 52.9% used erlotinib and 23.5% gefitinib. Patient baseline characteristics of analyzed 182 patients were: average age of 64.3 years, 67.2 kilos, 1.6 m height, and 1.74mbody surface area. Nineteen treatment regimens were identified and most patients received 3 cycles of treatment. The most common regimens in first, second, and third-line treatments were carboplatin+pemetrexed (31%), docetaxel monotherapy (57.1%), and erlotinib (80%), respectively. The proportion of patients with NSCLC that undergo first, second, third, fourth, and fifth-line treatments in one year was 46.2/100, 20.5/100, 3.7/100, 0.7/100, and 1.1/100, respectively.  CONCLUSIONS:

Mutation testing was very low, representing a significant unmet need, as patients with mutations may not be receiving appropriate targeted treatment in first-line.