Swansea Bay University Health Board, Port Talbot, UK.
Clatterbridge Cancer Centre, Wirral, UK.
BMC Cancer. 2021 May 7;21(1):515. doi: 10.1186/s12885-021-08096-w.
The treatment landscape for advanced non-small cell lung cancer (aNSCLC) has evolved rapidly since immuno-oncology (IO) therapies were introduced. This study used recent data to assess real-world treatment patterns and clinical outcomes in aNSCLC in the United Kingdom.
Electronic prescribing records of treatment-naive patients starting first-line (1 L) treatment for aNSCLC between June 2016 and March 2018 (follow-up until December 2018) in the United Kingdom were assessed retrospectively. Patient characteristics and treatment patterns were analyzed descriptively. Outcomes assessed included overall survival (OS), time to treatment discontinuation, time to next treatment, and real-world tumor response.
In all, 1003 patients were evaluated (median age, 68 years [range, 28-93 years]; 53.9% male). Use of 1 L IO monotherapy (0-25.9%) and targeted therapy (11.8-15.9%) increased during the study period, but chemotherapy remained the most common 1 L treatment at all time points (88.2-58.2%). Median OS was 9.5 months (95% CI, 8.8-10.7 months) for all patients, 8.1 months (95% CI, 7.4-8.9 months) with chemotherapy, 14.0 months (95% CI, 10.7-20.6 months) with IO monotherapy, and 20.2 months (95% CI, 16.0-30.5 months) with targeted therapy. In the 28.6% of patients who received second-line treatment, IO monotherapy was the most common drug class (used in 51.6%).
Although use of 1 L IO monotherapy for aNSCLC increased in the United Kingdom during the study period, most patients received 1 L chemotherapy. An OS benefit for first-line IO monotherapy vs chemotherapy was observed but was numerically smaller than that reported in clinical trials. Targeted therapy was associated with the longest OS, highlighting the need for improved treatment options for tumors lacking targetable mutations.
免疫肿瘤学(IO)疗法问世以来,晚期非小细胞肺癌(aNSCLC)的治疗格局迅速发展。本研究利用最新数据评估了英国 aNSCLC 的真实世界治疗模式和临床结局。
回顾性评估了 2016 年 6 月至 2018 年 3 月(随访至 2018 年 12 月)期间英国开始一线(1L)治疗的初治患者的电子处方记录。对患者特征和治疗模式进行了描述性分析。评估的结局包括总生存期(OS)、治疗中断时间、下一次治疗时间和真实世界的肿瘤反应。
共评估了 1003 例患者(中位年龄 68 岁[范围 28-93 岁];53.9%为男性)。1L IO 单药治疗(0-25.9%)和靶向治疗(11.8-15.9%)的使用率在研究期间有所增加,但化疗在所有时间点仍然是最常见的 1L 治疗(88.2-58.2%)。所有患者的中位 OS 为 9.5 个月(95%CI,8.8-10.7 个月),化疗组为 8.1 个月(95%CI,7.4-8.9 个月),IO 单药治疗组为 14.0 个月(95%CI,10.7-20.6 个月),靶向治疗组为 20.2 个月(95%CI,16.0-30.5 个月)。在接受二线治疗的 28.6%的患者中,IO 单药治疗是最常见的药物类别(51.6%)。
尽管研究期间英国 aNSCLC 的 1L IO 单药治疗使用率有所增加,但大多数患者仍接受 1L 化疗。与化疗相比,一线 IO 单药治疗的 OS 获益观察到但数值较小,低于临床试验报道。靶向治疗与最长的 OS 相关,突出了需要为缺乏可靶向突变的肿瘤提供更好的治疗选择。