Advertisement

Treatment Patterns for Advanced Non–Small-cell Lung Cancer After Platinum-containing Therapy in U.S. Community Oncology Clinical Practice

Published:March 29, 2016DOI:https://doi.org/10.1016/j.cllc.2016.03.008

      Abstract

      Background

      Knowledge of the real-world treatment patterns for non–small-cell lung cancer (NSCLC) can identify quality-of-care gaps and guide resource allocation needs. Our objective was to describe the treatment patterns for advanced NSCLC after first-line chemotherapy in the era before the approval of immunotherapeutic agents.

      Materials and Methods

      The present was a retrospective observational study of adult patients with advanced NSCLC (stage IIIB/IV or metastatic recurrence) who had completed a platinum-containing regimen, with an appropriate tyrosine kinase inhibitor if positive for epidermal growth factor receptor mutation or anaplastic lymphoma kinase translocation. Eligible patients initiated second-line chemotherapy from November 2012 through October 2014, recorded in an oncology record system for U.S. community clinics.

      Results

      Of 6867 patients with advanced NSCLC, 4188 (61%) initiated and 2707 (39%) completed platinum therapy, with a tyrosine kinase inhibitor, if appropriate. Subsequently 1889 of 2707 (70%) received second-line chemotherapy, including 1173 within the study period (844 [72%] nonsquamous, 275 [23%] squamous, and 54 [5%] not otherwise specified). The mean ± standard deviation patient age was 66 ± 10 years; 54% were male. Of the 94 different second-line regimens, docetaxel was the most common, prescribed to 14% of the patients overall and 14% and 16% of the nonsquamous and squamous cohorts, respectively. The median duration was 64 days (range, 1-455 days) and 48 days (range, 1-210 days) for the nonsquamous and squamous cohorts, respectively. The median duration by regimen category was 15 to 85 days (overall range, 1-953 days).

      Conclusion

      These findings show the diversity, short treatment duration, and lack of efficacy of second-line chemotherapy regimens for NSCLC in the community oncology setting.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Lung Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. National Cancer Institute. SEER Cancer Statistics Factsheets: Lung and Bronchus Cancer. 2015. Available at: http://seer.cancer.gov/statfacts/html/lungb.html. Accessed: November 30, 2015.

      2. Howlader N, Noone AM, Krapcho M, et al, eds. Surveillance, Epidemiology, and End Results (SEER) Program. SEER Cancer Statistics Review, 1975-2012 (updated August 20, 2015). National Cancer Institute, Bethesda, MD. Available at: http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER web site, April 2015. Accessed: November 30, 2015.

        • Herbst R.S.
        • Heymach J.V.
        • Lippman S.M.
        Lung cancer.
        N Engl J Med. 2008; 359: 1367-1380
        • Travis W.D.
        • Brambilla E.
        • Nicholson A.G.
        • et al.
        The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification.
        J Thorac Oncol. 2015; 10: 1243-1260
        • Reck M.
        • Paz-Ares L.
        Immunologic checkpoint blockade in lung cancer.
        Semin Oncol. 2015; 42: 402-417
        • Gridelli C.
        • de Marinis F.
        • Cappuzzo F.
        • et al.
        Treatment of advanced non-small-cell lung cancer with epidermal growth factor receptor (EGFR) mutation or ALK gene rearrangement: results of an international expert panel meeting of the Italian Association of Thoracic Oncology.
        Clin Lung Cancer. 2014; 15: 173-181
      3. National Comprehensive Cancer Network. NCCN guidelines: non-small cell lung cancer version 7.2015. Available at: http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Accessed: November 30, 2015.

        • Reck M.
        • Popat S.
        • Reinmuth N.
        • et al.
        Metastatic non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up.
        Ann Oncol. 2014; 25: iii27-iii39
        • Masters G.A.
        • Temin S.
        • Azzoli C.G.
        • et al.
        Systemic therapy for stage IV non-small-cell lung cancer: American Society of Clinical Oncology clinical practice guideline update.
        J Clin Oncol. 2015; 33: 3488-3515
        • Lindeman N.I.
        • Cagle P.T.
        • Beasley M.B.
        • et al.
        Molecular testing guideline for selection of lung cancer patients for EGFR and ALK tyrosine kinase inhibitors: guideline from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology.
        J Thorac Oncol. 2013; 8: 823-859
        • Besse B.
        • Adjei A.
        • Baas P.
        • et al.
        2nd ESMO Consensus Conference on Lung Cancer: non-small-cell lung cancer first-line/second and further lines of treatment in advanced disease.
        Ann Oncol. 2014; 25: 1475-1484
        • Ramsey S.D.
        • Martins R.G.
        • Blough D.K.
        • et al.
        Second-line and third-line chemotherapy for lung cancer: use and cost.
        Am J Manag Care. 2008; 14: 297-306
        • Gerber D.E.
        • Rasco D.W.
        • Le P.
        • et al.
        Predictors and impact of second-line chemotherapy for advanced non-small cell lung cancer in the United States: real-world considerations for maintenance therapy.
        J Thorac Oncol. 2011; 6: 365-371
        • Henk H.J.
        • Ray S.
        Treatment patterns and healthcare costs among patients with advanced non–small-cell lung cancer.
        Lung Cancer Manage. 2013; 2: 189-197
        • Pan I.W.
        • Mallick R.
        • Dhanda R.
        • et al.
        Treatment patterns and outcomes in patients with non-squamous advanced non-small cell lung cancer receiving second-line treatment in a community-based oncology network.
        Lung Cancer. 2013; 82: 469-476
        • Davis K.L.
        • Goyal R.K.
        • Able S.L.
        • et al.
        Real-world treatment patterns and costs in a US Medicare population with metastatic squamous non-small cell lung cancer.
        Lung Cancer. 2015; 87: 176-185
      4. Flatiron Health. Available at: http://www.flatiron.com/life-sciences. Accessed: November 30, 2015.

      5. Health Insurance Portability and Accountability Act of 1996. Available at: https://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/HIPAAGenInfo/Downloads/HIPAALaw.pdf. Accessed: November 30, 2015.

        • Busby L.T.
        • Sheth S.
        • Garey J.
        • et al.
        Creating a process to standardize regimen order sets within an electronic health record.
        J Oncol Pract. 2011; 7: e8-e14
        • Reinmuth N.
        • Payer N.
        • Muley T.
        • et al.
        Treatment and outcome of patients with metastatic NSCLC: a retrospective institution analysis of 493 patients.
        Respir Res. 2013; 14: 139
        • Sacher A.G.
        • Le L.W.
        • Lau A.
        • et al.
        Real-world chemotherapy treatment patterns in metastatic non-small cell lung cancer: are patients undertreated?.
        Cancer. 2015; 121: 2562-2569
        • Odabas H.
        • Ulas A.
        • Aydin K.
        • et al.
        Is second-line systemic chemotherapy beneficial in patients with non-small cell lung cancer (NSCLC)? A multicenter data evaluation by the Anatolian Society of Medical Oncology.
        Tumour Biol. 2015; 36: 9641-9648
        • Kocher F.
        • Hilbe W.
        • Seeber A.
        • et al.
        Longitudinal analysis of 2293 NSCLC patients: a comprehensive study from the TYROL registry.
        Lung Cancer. 2015; 87: 193-200
        • Gridelli C.
        • de Marinis F.
        • Ardizzoni A.
        • et al.
        Advanced non-small cell lung cancer management in patients progressing after first-line treatment: results of the cross-sectional phase of the Italian LIFE observational study.
        J Cancer Res Clin Oncol. 2014; 140: 1783-1793
        • Skov B.G.
        • Hogdall E.
        • Clementsen P.
        • et al.
        The prevalence of EGFR mutations in non-small cell lung cancer in an unselected Caucasian population.
        APMIS. 2015; 123: 108-115
        • Szumera-Cieckiewicz A.
        • Olszewski W.T.
        • Tysarowski A.
        • et al.
        EGFR mutation testing on cytological and histological samples in non-small cell lung cancer: a Polish, single institution study and systematic review of European incidence.
        Int J Clin Exp Pathol. 2013; 6: 2800-2812
        • Gainor J.F.
        • Varghese A.M.
        • Ou S.H.
        • et al.
        ALK rearrangements are mutually exclusive with mutations in EGFR or KRAS: an analysis of 1,683 patients with non-small cell lung cancer.
        Clin Cancer Res. 2013; 19: 4273-4281
        • Lee J.K.
        • Kim T.M.
        • Koh Y.
        • et al.
        Differential sensitivities to tyrosine kinase inhibitors in NSCLC harboring EGFR mutation and ALK translocation.
        Lung Cancer. 2012; 77: 460-463
        • Kwak E.L.
        • Bang Y.J.
        • Camidge D.R.
        • et al.
        Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer.
        N Engl J Med. 2010; 363: 1693-1703

      Reference

      1. National Center for Health Statistics. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Available at: http://www.cdc.gov/nchs/icd/icd9cm.htm. Accessed: November 27, 2015.