Treatment Patterns and Overall Survival Associated with First-Line Systemic Therapy for Patients with Advanced...

Area of Science:

• Oncology
• Clinical Research
• Health Services Research

Background:

• First-line treatment for advanced non-small cell lung cancer (NSCLC) varies based on patient factors.
• Regimens include combination therapies and single agents.

Purpose of the Study:

• To describe first-line therapies for advanced NSCLC.
• To compare overall survival (OS) among different treatment regimens in an integrated healthcare system.

Main Methods:

• Retrospective cohort study of advanced NSCLC patients (Stage IIIB/IV).
• Data collected from Kaiser Permanente California (2008-2013).
• Treatment regimens categorized into 6 groups: platinum doublets, pemetrexed-based, bevacizumab-based, pemetrexed + bevacizumab, singlets, and tyrosine-kinase inhibitors (TKIs). OS compared using Kaplan-Meier curves and Cox models; subgroup analyses by age and histology.

Main Results:

• Over 2,000 patients received platinum doublets (52.3%), TKIs (19.0%), pemetrexed-based (13.4%), bevacizumab-based (8.0%), singlets (5.5%), or pemetrexed + bevacizumab (1.8%).
• Median survival was longest for pemetrexed + bevacizumab (18.5 months) and bevacizumab-based (14.5 months) regimens.
• Pemetrexed + bevacizumab combinations and TKIs showed significantly reduced mortality risk compared to doublets. Singlets increased mortality risk.

Conclusions:

• Pemetrexed + bevacizumab combinations and TKIs offered survival advantages for younger patients (<65) with advanced NSCLC.
• No significant survival advantage was observed for older patients receiving bevacizumab or pemetrexed compared to platinum doublets.
• Combination therapy with platinum and taxane may be suitable for older patients not eligible for targeted therapy.