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Second and later-line erlotinib use in non-small cell lung cancer: real world outcomes and practice patterns overtime
Kirstin Perdrizet1,2,3,4, Rinku Sutradhar4,5,6, Qing Li5
1Department of Oncology and Hematology, Princess Margaret Cancer Centre/University Health Network, Toronto, Canada.
Background:
In Canada, epidermal growth factor receptor (EGFR) inhibitor therapies in advanced non-small cell lung cancer (NSCLC) were initially approved regardless of EGFR status. The purpose of this study is to characterise the use of second or later-line erlotinib therapy in Ontario, Canada from 2007-2016, as well as evaluate the impact of erlotinib therapy on survival and emergency department (ED) visits in a real-world population.
Methods:
This is a retrospective cohort study derived at ICES (formerly known as the Institute for Clinical and Evaluative Sciences) of advanced NSCLC patients diagnosed from 2007-2016 in Ontario, Canada, over the age of 65, who received at least one dose of first-line chemotherapy. The exposure of interest was receipt of second or later-line erlotinib. The primary outcome was the hazard ratio for mortality evaluated using a Cox proportional hazards model, and the secondary outcome, ED visits, was evaluated using a Poisson model.
Results:
First-line chemotherapy was administered in 30.4% of stage IV NSCLC patients. Of these patients, 19.7% received second or later-line erlotinib. The proportion of patients prescribed second or later-line erlotinib decreased over the course of the study (P<0.0001). Unadjusted median overall survival in the entire cohort was 325 days (95% CI: 314-337 days), 513 days (95% CI: 485-539 days) in the erlotinib cohort, and 282 days (95% CI: 270-291 days) in the non-erlotinib cohort. Despite this, the adjusted hazard ratio for death was 1.89 (95% CI: 1.73-2.07, P<0.0001) for patients on erlotinib. Patients receiving erlotinib also had a marginally higher relative rates of ED visits with an adjusted relative risk of 1.10 (95% CI: 1.02-1.19, P=0.013).
Conclusions:
This study highlights the importance of using EGFR targeted treatments in NSCLC patients with a predictive biomarker, and suggests that treatment with erlotinib therapy is unlikely to benefit unselected patients with advanced NSCLC.
Insights
Erlotinib therapy for advanced non-small cell lung cancer (NSCLC) in unselected patients did not improve survival and increased emergency department visits. Targeted epidermal growth factor receptor (EGFR) treatments are crucial for NSCLC patients with predictive biomarkers.
Area of Science:
- Oncology
- Pharmacotherapy
- Real-world evidence
Background:
- Epidermal growth factor receptor (EGFR) inhibitor therapies for advanced non-small cell lung cancer (NSCLC) were initially approved in Canada irrespective of EGFR mutation status.
- Real-world data on the utilization and outcomes of second or later-line erlotinib in advanced NSCLC patients are limited.
Purpose of the Study:
- To characterize the use of second or later-line erlotinib in advanced NSCLC patients aged over 65 in Ontario, Canada (2007-2016).
- To evaluate the impact of erlotinib therapy on overall survival and emergency department (ED) visits in a real-world population.
Main Methods:
- Retrospective cohort study of advanced NSCLC patients (diagnosed 2007-2016, aged >65) who received first-line chemotherapy.
- Exposure: receipt of second or later-line erlotinib.
- Outcomes: mortality (Cox proportional hazards model) and ED visits (Poisson model).
Main Results:
- 19.7% of eligible NSCLC patients received second or later-line erlotinib, with decreasing prescription rates over time.
- Erlotinib use was associated with a significantly higher adjusted hazard ratio for death (1.89) and marginally higher ED visit rates (RR 1.10).
- Unadjusted median survival was longer in the erlotinib cohort (513 days) compared to the non-erlotinib cohort (282 days), but adjusted analyses revealed worse outcomes with erlotinib.
Conclusions:
- Treatment with erlotinib is unlikely to benefit unselected advanced NSCLC patients.
- Highlights the importance of utilizing EGFR-targeted treatments in NSCLC patients with predictive biomarkers.
- Real-world data underscore the need for biomarker-guided therapy selection in advanced NSCLC.
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