Real-world practice patterns for patients with advanced non-small cell lung cancer: multicenter retrospective cohort study in Japan

Abstract

BackgroundRecommended therapies for advanced/metastatic non-small cell lung cancer (NSCLC) have changed with the advent of targeted therapies. The objectives of this retrospective chart review study were to describe treatment patterns, biomarker testing practices, and health care resource use for advanced NSCLC at 5 sites in Japan.Patients and methodsWe studied anonymized medical record data of patients aged ≥18 years who initiated systemic therapy for newly diagnosed stage IIIB or IV NSCLC from January 2011 through June 2013. Data were analyzed descriptively by histology and mutation status. Overall survival was estimated using the Kaplan–Meier method.ResultsWe studied 175 patients, including 43 (25%), 129 (74%), and 3 (2%) with squamous, nonsquamous, and unknown NSCLC histology, respectively; 83% had stage IV NSCLC. Overall, 123 patients (70%) were male; the median age was 70 years (range, 47–86); and 33 (19%) were never-smokers. In the nonsquamous cohort, 105 (81%) and 25 (19%) of patients were tested for epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement, respectively; 44 (42%) had EGFR-positive NSCLC and 2 (8%) had ALK-positive NSCLC, including 26/46 (57%) women and 21/46 (46%) never-smokers. In the squamous cohort, 17 (40%) and 4 (9%), respectively, were tested; 1 EGFR-positive tumor was detected. After first-line therapy, 105 (60%) patients received second-line, and 54/105 (51%; or 31% overall) received third-line therapy. EGFR tyrosine kinase inhibitors were most commonly prescribed for EGFR-positive NSCLC across all lines. In the nonsquamous EGFR/ALK-negative/unknown cohort, most received first-line platinum combinations, particularly younger patients (78% ≥75 years vs 93% <75 years old). The average hospitalization was 21 days/admission. The median (95% CI) overall survival from start of first-line therapy was 9.9 months (7.6–11.7) for all patients and 17.9 months (9.9–24.4) for patients with EGFR/ALK-positive status.ConclusionBiomarker testing is common for nonsquamous NSCLC at the 5 Japanese study sites. Treatment is personalized by mutation status and age, per guideline recommendations.

Real-world management of patients with epidermal growth factor receptor (EGFR) mutation-positive non–small-cell lung cancer in the USA

“…However, the population studied in the USA may not be representative of a global population, and additional analyses may be needed to evaluate real-world treatment patterns in other countries. In a retrospective chart review examining real-world practice patterns in 175 Japanese patients treated for stage IIB/IV NSCLC between 2011 and 2013, EGFR TKIs were the most commonly prescribed therapies for EGFR Mut+ NSCLC across all treatment lines [26], similar to our findings. Of note, median OS from the start of first-line therapy was 9.9 months (95% CI 7.6–11.7) for all patients compared with 17.9 months (95% CI 9.9–24.4) for those with EGFR / ALK Mut+ tumors.…”

“…Of note, median OS from the start of first-line therapy was 9.9 months (95% CI 7.6–11.7) for all patients compared with 17.9 months (95% CI 9.9–24.4) for those with EGFR / ALK Mut+ tumors. The authors note that due to the retrospective nature of the study, these results are not reflective of the current clinical landscape, given the availability of newer therapies for NSCLC, namely third-generation EGFR TKIs [26,27].…”

Molecular testing and treatment patterns for patients with advanced non-small cell lung cancer: PIvOTAL observational study

“…A total of 1440 patients were included in the study from 78 academic and community oncology sites in 8 countries. The demographic and clinical characteristics of all patients have been described by country in previous publications [ 33 , 34 ]. The majority of patients in each country were male (from 53% in Germany to 77% in Spain) and current or former smokers (63% in Korea to 86% in Australia), with the exception of Taiwan (47% male and 33% current or former smokers).…”

Treatment Pattern and Overall Survival of Patients with Advanced Non-Squamous Non-Small Cell Lung Cancer: A Multicentric Real-World Study in China (CTONG1506)

“…However, platinum-based regimen remains the standard treatment for patients without mutations in China with gemcitabine, docetaxel, paclitaxel and pemetrexed being the most common choices for 1st line chemotherapy (21). A retrospective chart review study examining realworld treatment pattern in Japan revealed EGFR TKIs to be the most commonly prescribed drug for EGFR mutated NSCLC across all treatment lines (22).…”