Soo Ross A, Seto Takashi, Gray Jhanelle E, Thiel Ellen, Taylor Aliki, Sawyer William, Karimi Parisa, Marchlewicz Elizabeth, Brouillette Matthew
Department of Haematology-Oncology, National University Cancer Institute, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 7, Singapore, 119228, Singapore.
Department of Thoracic Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
Drugs Real World Outcomes. 2022 Mar;9(1):31-41. doi: 10.1007/s40801-021-00272-5. Epub 2021 Sep 12.
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.
To retrospectively examine treatment patterns in locally advanced/metastatic NSCLC using MarketScan Commercial and Medicare Supplemental Databases (all US census regions).
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).
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%).
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.
大多数表皮生长因子受体突变阳性（EGFRm）的非小细胞肺癌（NSCLC）患者会对一线（1L）第一代或第二代（1G/2G）EGFR-TKI产生耐药性；因此，优化一线治疗以改善患者预后非常重要。
利用MarketScan商业数据库和医疗保险补充数据库（涵盖美国所有人口普查地区），回顾性研究局部晚期/转移性NSCLC的治疗模式。
分析2015年1月1日至2018年3月31日期间诊断为肺癌的成年患者，从诊断（索引）开始进行可变长度的随访。患者在索引日期或之后60天内有≥1次1G/2G EGFR-TKI的药房配药记录。数据按有无中枢神经系统（CNS）转移（索引前30天至研究结束）进行分层。
共纳入578例患者（中位年龄63岁，64%为女性）。中位随访时间为13.5个月。最常处方的一线EGFR-TKI是厄洛替尼（414/578，72%）。在任何时间诊断为CNS转移的患者中，一线治疗停药的中位时间为8.2（95%置信区间（CI）6.9，9.0）个月，无CNS转移的患者为7.7（95%CI 6.9，8.9）个月。270/578例患者（47%）停用一线EGFR-TKI；209/270例（77%）开始二线（2L）治疗，最常使用奥希替尼（96/209，46%）。
在美国索赔数据分析中，近一半患者停用一线EGFR-TKI，开始二线治疗的患者中有46%接受奥希替尼治疗。由于近四分之一停用一线EGFR-TKI的患者未接受二线治疗，本研究强调了在EGFRm局部晚期/转移性NSCLC中进行优化一线治疗的必要性。
