A new study comparing first-line therapies for patients with advanced non-small cell lung cancer (NSCLC) suggests a survival advantage of one treatment regimen in younger patients, published in the Journal of Managed Care & Specialty Pharmacy.
-----
Related Content
First-Line Pembrolizumab for NSCLC Improves HRQoL Versus Chemotherapy
Two Studies Support Immunotherapeutic Agent As First-Line Treatment for NSCLC
-----
First-line treatment for NSCLC depends on histology, molecular profile, and performance status, but the survival benefits of different treatment options have not been directly compared.
To address this question, researchers led by Michele M Spence, PhD, Pharmacy Outcomes Research Group, Kaiser Permanente Southern California, evaluated first-line treatment regimens used in 2081 patients aged 18 years or older with stage IIIB or IV NSCLC who underwent first systemic treatment from 2008 to 2013. Analyses were performed separately for patients older and younger than 65 years of age. The findings were reported in the Journal of Managed Care and Specialty Pharmacy (2017;23[2]:195-205).
Treatment regimens used in this cohort of patients included a platinum agent with or without pemetrexed or bevacizumab, a tyrosine-kinase inhibitor (TKI), or a single agent. Across all age groups, median survival was longest for those treated with pemetrexed and bevacizumab-based combinations (18.5 months), followed by bevacizumab-based regimens (14.5 months), TKIs (12.7 months), pemetrexed-based regimens (10.4 months), platinum doublets (9.2 months), and singlets (5.3 months). Risk of mortality among patients treated with pemetrexed and bevacizumab combinations or TKIs was significantly lower than those treated with platinum doublets. Singlets were associated with increased risk of mortality.
Researchers also found that different treatment regimens offer improved rates of survival for patients with NSCLC depending on age group. Analysis of patients aged 65 years or older showed a higher risk of mortality with singlet treatment compared with platinum doublets. No survival advantage was seen for patients who received bevacizumab or pemetrexed compared with those who receive platinum doublets, however. Researchers concluded that a combination of a platinum agent and either carboplatin and paclitaxel may therefore be an option for patients who are not candidates for targeted therapy, though this requires further investigation.
For patients younger than 65 years of age, pemetrexed and bevacizumab-based combinations and TKIs were associated with lower risks of mortality, with combinations conferring a survival advantage over platinum doublets. Further study should be done to verify the survival benefits of these treatment approaches, the authors noted.
