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[Real-life first-line systemic treatments for metastatic non-small cell lung cancer (mNSCLC) - Data from the
Romain Corre1, Hervé Léna2, Adrien Eberlin3
1Service de pneumologie, centre hospitalier de Cornouaille, Quimper, France.
Abstract:
Immunotherapy has revolutionized the management of metastatic non-small cell lung cancer (NSCLC) without targetable alterations. Its use depends on histology, tumor PD-L1 expression, Performance Status (PS) score and patient age. The objective is to describe real-life therapeutic attitudes in France in 2020 and to analyze the adequacy with the professional standards applicable. The KBP-2020 study is a prospective observational study, including patients diagnosed de novo with primary lung cancer in 2020, followed in France in the participating non-university hospitals. Retrospective data analysis provides information on the first-line distribution of systemic treatments (immunotherapy, chemotherapy or the combination of both) in patients with stage IV NSCLC (542 squamous and 2082 non-squamous) without ALK rearrangement/alteration or EGFR mutations and PS score≤2. Immunotherapy alone or combined with chemotherapy is prescribed according to tumor PD-L1 expression: in case of PD-L1≥50%, in 85.2% of non-squamous and 86.6% of squamous patients, in case of PD-L1 [1-49%], in 61.7% of non-squamous and 45% of squamous patients and in case of PD-L1<1%, immunotherapy alone or combined with chemotherapy is prescribed in 56.48% of non-squamous and 30.86% of squamous patients. The use of immunotherapy in real life in 2020 in France shows an apparent gap with national guidelines that is more marked in cases of squamous cell NSCLC or with PD-L1 expression<50% with less exposure of patients to the immunotherapy-chemotherapy combination compared to current recommendations. This gap could be partly explained by the progressive reimbursement schedule of pembrolizumab and by other factors not documented in KBP-2020-CPHG.
Insights
Real-world immunotherapy use in metastatic non-small cell lung cancer (NSCLC) in France revealed gaps with national guidelines, particularly for squamous NSCLC and lower PD-L1 expression. Treatment patterns showed less combination therapy than recommended.
Area of Science:
- Oncology
- Clinical Research
- Pharmacotherapy
Background:
- Immunotherapy has transformed metastatic non-small cell lung cancer (NSCLC) treatment for patients lacking targetable alterations.
- Treatment decisions are guided by histology, PD-L1 expression, Performance Status (PS), and age.
Purpose of the Study:
- To evaluate real-world treatment practices for metastatic NSCLC in France in 2020.
- To assess adherence to national professional standards for immunotherapy use.
Main Methods:
- Prospective observational study (KBP-2020) in French non-university hospitals.
- Retrospective analysis of first-line systemic treatments in stage IV NSCLC patients (PS ≤2) without ALK/EGFR alterations.
- Data collected on immunotherapy, chemotherapy, and combination therapy based on PD-L1 expression.
Main Results:
- Immunotherapy (alone or combined) prescription varied by PD-L1 expression levels across squamous and non-squamous NSCLC.
- For PD-L1 ≥50%, immunotherapy was used in 85.2% (non-squamous) and 86.6% (squamous).
- For PD-L1 <1%, immunotherapy use was 56.48% (non-squamous) and 30.86% (squamous).
Conclusions:
- Real-world immunotherapy use in France in 2020 showed discrepancies with national guidelines.
- The gap was more pronounced in squamous NSCLC and tumors with PD-L1 <50%.
- Underutilization of immunotherapy-chemotherapy combinations may be linked to reimbursement schedules and other unrecorded factors.
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