Real-world treatment patterns among advanced non-small cell lung cancer patients in the US

A descriptive cohort study was conducted using a specialized electronic health record data for NSCLC. Patients who initiated NSCLC treatment following diagnosis of advanced NSCLC (stage IIIB/IIIC/IV) from 01/01/2015–12/31/2021 were identified. Baseline characteristics and treatment patterns were described; continuous variables were described as mean and standard deviation (SD) and categorical variables as proportions.

Of 8,811 patients identified with advanced NSCLC, 67.9% had non-squamous cell carcinoma, 22.5% had squamous cell carcinoma, and 9.6% had an unknown histology. The majority of patients (78.7%) were treated at community hospitals, while 13.4% were treated at academic centers, and 7.9% had an unknown treatment setting. Most patients (59.0%) were aged 65 years or older, and 47.3% were female. There were 22 patients (0.2%) with documentation of NSCLC but no identified guideline-recommended line of therapy (LoT). Among all patients, 51.6% received a second line of therapy (LoT2), and 26.4% received third-line therapy (LoT3). For stage IIIB/IIIC patients, the five most common first-line therapies (LoT1), accounting for 83.2% of all LoT1, included traditional platinum-based chemotherapy or pembrolizumab. In stage IV patients, the five most common LoT1, comprising 64.4% of all LoT1, were pembrolizumab either as monotherapy or combined with other platinum-based chemotherapeutic agents.

Traditional platinum-based chemotherapy was the most common LoT1 for stage IIIB/IIIC patients, while the extensive use of immunotherapy (IO) was found in stage IV patients and in later lines of treatment in stage IIIB/IIIC patients. Results indicate that new evidence regarding treatment patterns is rapidly adopted into practice and medication therapy management.