Real-World Treatment Patterns, Clinical Outcomes, and Health Care Resource Utilization in Extensive-Stage Small Cell Lung Cancer in Canada

Abstract

The prognosis for extensive-stage small cell lung cancer (ES-SCLC) is poor. Real-world evidence can highlight the unmet clinical need within this population. We conducted a population-based cohort study of ES-SCLC patients diagnosed in a large Canadian province (2010–2018) using electronic medical records and administrative claims data. In all, 1941 ES-SCLC patients were included, of which 476 (25%) were recurrent cases. Median age at diagnosis was 70 years (range: 39–94) and 50.2% were men. Of the 1941 ES-SCLC patients, 29.5% received chemotherapy and radiotherapy, 17.0% chemotherapy alone, 8.7% radiotherapy alone, and 44.8% received best supportive care. Chemotherapy was initiated by 46.5%, 8.5%, and 1.4% of first-, second-, and third-line patients, with lower uptake for recurrent cases. Median survival from first-, second-, and third-line chemotherapy was 7.82 months (95% CI: 7.50–8.22), 5.72 months (95% CI: 4.90–6.87), and 3.83 months (95% CI: 2.99–4.60). Among patients who received first-line therapy, the 2-year and 5-year survival was 7.3% (95% CI: 5.7–9.2) and 2.9% (95% CI: 1.8–4.5). In conclusion, initiation of first-line treatment in ES-SCLC was low with significant attrition in subsequent lines. These results underscore the need for effective front-line treatments and highlight the potential for novel therapies to improve patient outcomes.

Prevalence, Treatment Patterns, and Outcomes of Individuals with EGFR Positive Metastatic Non-Small Cell Lung Cancer in a Canadian Real-World Setting: A Comparison of Exon 19 Deletion, L858R, and Exon 20 Insertion EGFR Mutation Carriers

“…Treatment patterns were identified using an algorithm adapted from a previous lung cancer study [ 13 ]. The start date of the line of therapy was defined as the earliest date of systemic treatment given on or after the date of initial diagnosis.…”

Building infrastructure for outcomes-based agreements in Canada: can administrative health data be used to support an outcomes-based agreement in oncology?

“…These outcomes were deemed suitable based on criteria of data readiness (accessible for an OBA, complete, and accurate), data interpretation (health outcome is clear and simple), and data timeframe (can be collected in a reasonable timeframe). OS data are available through the Alberta Cancer Registry and Vital Statistics, have been used in published studies [ 2 ], and measure an objective event that can be easily and consistently interpreted. Diagnoses with relatively short anticipated OS timeframes could be suitable for an OBA.…”

“…Diagnoses with relatively short anticipated OS timeframes could be suitable for an OBA. TTNT data are accessible through the Alberta Pharmaceutical Information Network (PIN) database containing all prescription data in the province for all payers and have been used in published studies [ 2 , 10 ]. A coding algorithm must be developed to determine a specific treatment pattern, and data are generally accessible within 1 month of dispensing.…”

“…With the growing number of promising therapies with imperfect data, particularly in rare diseases and precision oncology, coupled with long reimbursement timelines, timely access to novel therapies has become increasingly challenging. Outcomes-based agreements (OBAs) have the potential to accelerate patients’ access to these therapies, while mitigating risk for payers [ 1 , 2 ]. Traditionally, an OBA is an agreement between a manufacturer and a payer in which the manufacturer will issue a refund or rebate to the payer based on how well the therapy performs in a real-world patient population, measured against an agreed-upon, pre-defined set of benchmarks.…”

Real World Patient Eligibility for Second Line Lurbinectedin Based Treatment in Small Cell Lung Cancer: Understanding Epidemiology and Estimating Health Care Utilization

“…Tobacco use accounts for the vast majority of new cases of SCLC with 98% of patients having a smoking history [ 1 ]. Due to the aggressive nature of SCLC, two thirds of patients present with incurable extensive stage (ES) disease with a median overall survival (OS) of just 10 months [ 2 , 3 ]. Unfortunately, even in the minority of patients who present with limited stage (LS) disease, treatment is rarely curable with only 16% of patients being alive at 5 years [ 4 ].…”