Treatment Patterns in Patients with Locally Advanced or Metastatic Non-Small-Cell Lung Cancer Treated with Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors: Analysis of US Insurance Claims Databases

Abstract

Background Most patients with epidermal growth factor receptor mutation-positive (EGFRm) non-small-cell lung cancer (NSCLC) acquire resistance to first-line (1L) first-or second-generation (1G/2G) EGFR-TKIs; therefore, it is important to optimize 1L treatment to improve patient outcomes. Objective To retrospectively examine treatment patterns in locally advanced/metastatic NSCLC using MarketScan ® Commercial and Medicare Supplemental Databases (all US census regions). Patients and methods Adults with a lung cancer diagnosis code between 1 January 2015-31 March 2018 were analyzed from diagnosis (index) through a variable-length follow-up. Patients had ≥ 1 pharmacy claim for 1G/2G EGFR-TKIs on or within 60 days post-index. Data were stratified by presence or absence of central nervous system (CNS) metastases (30 days pre-index through study end). Results 578 patients were included (median age 63 years, 64% female). Median follow-up was 13.5 months. The most frequently prescribed 1L EGFR-TKI was erlotinib (414/578, 72%). Median time to 1L treatment discontinuation was 8.2 (95% confidence interval (CI) 6.9, 9.0) months in patients diagnosed with CNS metastases at any time, and 7.7 (95% CI 6.9, 8.9) months in patients without CNS metastases. 270/578 patients (47%) discontinued 1L EGFR-TKIs; 209/270 (77%) initiated second-line (2L) therapy, most frequently osimertinib (96/209, 46%). Conclusions In an analysis of US claims data, nearly half of patients discontinued 1L EGFR-TKIs, and 46% who initiated 2L received osimertinib. As nearly a quarter of patients who discontinued 1L EGFR-TKIs did not receive 2L treatment, this study highlights the need for optimal 1L treatment in EGFRm locally advanced/metastatic NSCLC.

Real‐world treatment patterns of metastatic non‐small cell lung cancer patients receiving epidermal growth factor receptor tyrosine kinase inhibitors

“…This retrospective study using real‐world US claims data investigated a total of 2505 mNSCLC patients newly initiating 1L EGFR TKIs and described key patient characteristics and treatment patterns. Median ages of patients were similar across all three cohorts and the patients were predominantly female, which is consistent with the populations reported in other real‐world studies for 1L EGFR TKI use 11–13 and with the prevalence of EGFR mutations in women 22 …”

“…Moreover, the results of this real‐world study demonstrated a longer median 1L treatment duration with osimertinib (17.8 months) as compared with earlier generation EGFR TKIs (8.7 months for first‐generation and 10.5 months for second‐generation EGFR TKI) in the real‐world setting. Other retrospective database studies conducted using US claims data have reported similar median 1L treatment durations for first‐ and second‐generation EGFR TKIs, including 7.7–8.2 months for a combined cohort of EGFR TKIs 13 and 9.9 months for erlotinib and 12.1 months for afatinib 12 . Furthermore, time to treatment discontinuation has previously been shown to be a proxy for PFS 23 and we indeed found that the median durations of first‐ and second‐generation EGFR TKI treatments in this study were comparable to the median PFS reported in their respective clinical trials (9.7–13.3 months 3,24,25 for erlotinib and 11.0–11.1 months 26–28 for afatinib), as well as the median PFS for first‐generation EGFR TKIs reported in the phase III FLAURA trial (10.2 months) 29 .…”

“…9,10 Consequently, osimertinib is the preferred 1L EGFR TKI as per the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) in EGFRm mNSCLC. 1 There is published real world data on first-and secondgeneration EGFR TKIs [11][12][13] ; however, there is no published data on the real-world use of 1L osimertinib in comparison to other EGFR TKIs. Hence, this retrospective database analysis of mNSCLC patients was conducted to understand treatment patterns in patients treated with EGFR TKIs in the 1L setting, including type and duration of 1L treatment and second-line (2L) treatments.…”

Diagnostic-Therapeutic Pathway and Outcomes of Early Stage NSCLC: a Focus on EGFR Testing in the Real-World

“…At disease relapse, almost a quarter of patients received only locoregional treatment and all EGFR -mutant patients received an EGFR-TKI ( 20 , 21 ), as described in previous similar series of EGFR mutant NSCLC, eventually followed by a variety of combination therapies ( 22 , 23 ).…”

The Highly Selective Detection of Multiple Mutations of Exon 19 from Epidermal Growth Factor Receptor Gene in Single Tube Using the Colorimetric Assay

“…The main primary types of lung cancer is non-small-cell lung carcinoma (NSCLC), which is characterized by poor prognosis and long asymptomatic [1][2][3][4]. Some genes that encode signaling proteins that are crucial for cellular proliferation and survival, such as epidermal growth factor receptor (EGFR) gene, had found to have many different mutations in tumor tissue, and these mutations are related to selection of appropriate therapy [5][6][7][8][9]. Some new therapeutic agents, such as the epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) ge tinib and erlotinib, can produce a response for only NSCLCs carrying an EGFR mutation [10,11].…”