Results of a recent study offer insight into the effects of shifting treatment patterns of non-small cell lung cancer (NSCLC) treatment on patient outcomes, and for furthering community oncology benchmark initiatives, published in PLOS One (published online June 23, 2017; doi:10.1371/journal.pone.0178420).
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Current guideline recommendations for systemic therapy for stage IV NSCLC vary according to tumor histology and driver oncogene biomarker status, most frequently epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) translocation. Almost 85% of stage IV NSCLC do not exhibit EGFR mutations or ALK translocation. Treatment patterns for NSCLC and their associated overall survival (OS) provide important data for interpreting clinical trial results and for clinical practice benchmarking of high-quality care. However, limited data exists to describe treatment patterns and survival for metastatic NSCLC without EGFR mutations and/or ALK translocation.
Amy P Abernethy, MD, school of medicine, Duke University (Durham, NC), and colleagues conducted a study to describe OS with current first-line treatment for patients with stage IV NSCLC without known EGFR or ALK tumor aberrations across United States community oncology practices. Researchers samples 2014 patients (22% with squamous histology, 78% with nonsquamous histology; mean age, 67 years; 87% with smoking history) from 162 practices initiating first-line therapy. The time period of the study was from 2012 to 2015 to set a baseline for care and OS from contemporary first-line treatments prescribed before immune checkpoint inhibitors came to prevalence.
Researchers found that patients with nonsquamous NSCLC were most commonly treated with carboplatin plus pemetrexed either without (25.7%) or with bevacizumab (16%). Median OS for patients with this histology was 10.0 months (95% CI, 9.4-10.8).
Patients with squamous NSCLC were most often treated with carboplatin plus paclitaxel (37.6%) or nab-paclitaxel (21.1%). Median OS for these patients was 8.5 months (95% CI, 7.4-10.0).
Data showed overall median OS among all patients was 9.7 months (95% CI, 9.1-10.3).
Researchers concluded that their study was the first observational assessment of OS in first-line metastatic stage IV NSCLC without actionable mutations. Resulting data extends the current understanding of contemporary treatment patterns and outcomes in the US community oncology setting.
“Results of this study provide a necessary starting point for benchmarking high-quality care as new therapies for NSCLC are introduced into clinical practice,” researchers wrote.—Zachary Bessette
