Real-world treatment patterns and attrition for non-driver mutation metastatic non-small cell lung cancer in the US

Area of Science:

• Oncology
• Immunotherapy
• Lung Cancer Research

Background:

• Programmed cell death protein-1/ligand-1 (PD-1/PD-L1) inhibitors are standard of care for metastatic non-small cell lung cancer (mNSCLC).
• Real-world treatment patterns and outcomes for patients with non-driver mutation mNSCLC are not well-characterized.
• Understanding treatment attrition across lines of therapy (LOTs) is crucial for improving patient outcomes.

Purpose of the Study:

• To examine real-world treatment patterns and attrition by lines of therapy (LOTs) among patients with non-driver mutation mNSCLC.
• To analyze the utilization of PD-(L)1 inhibitors stratified by PD-L1 expression levels.
• To assess mortality and treatment duration across multiple lines of therapy.

Main Methods:

• Retrospective study of adult patients with mNSCLC (2015-2022) from a US multicenter database.
• Analysis of treatment patterns, duration, and outcomes, including PD-(L)1 utilization based on PD-L1 expression (<1%, 1%-49%, ≥50%).
• Descriptive summarization of mortality and attrition rates across LOTs 1-4.

Main Results:

• PD-(L)1-based therapy was the most common frontline treatment (55.8%), often in combination with platinum chemotherapy.
• Frontline PD-(L)1 monotherapy was most common in patients with high PD-L1 expression (≥50%).
• Mortality ranged from 37.4%-42.2% across LOTs 1-4, with approximately 60% attrition per LOT and a median LOT1 duration of 5.4 months.

Conclusions:

• High mortality and attrition persist in early lines of therapy for mNSCLC, despite the use of PD-(L)1 inhibitors.
• Short treatment durations highlight significant challenges in managing mNSCLC.
• Further strategies are needed to improve long-term outcomes for mNSCLC patients.