Treatments and Outcomes After Platinum-Based Chemotherapy and Anti-PD-(L)1 in NSCLC.

IMPORTANCE

Effective treatments for advanced or metastatic non-small cell lung cancer (NSCLC) are limited. Understanding clinical treatment patterns is critical for understanding unmet medical needs.

OBJECTIVE

To describe clinical treatment patterns and outcomes, including time to treatment discontinuation, progression-free survival, and overall survival, in patients who received platinum-based chemotherapy and anti-programmed cell death 1 protein or programmed cell death ligand 1 (PD-[L]1) regimens.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from 2018 to 2023 from a US nationwide, electronic health record-derived, deidentified database with median duration of follow-up of 7.8 (range, 0-65.0) months. Patients 18 years or older with advanced or metastatic NSCLC in second- and third-line treatment settings were included. Eligible patients had an Eastern Cooperative Oncology Group performance status of 0 or 1, received platinum-based chemotherapy and anti-PD-(L)1 therapy in 1 (combination) or 2 (sequential) lines, and initiated at least 1 subsequent treatment between January 1, 2018, and June 30, 2023. Exclusion criteria included disease progression within 8 weeks after anti-PD-(L)1 treatment initiation. Follow-up was until death or last available data through June 30, 2023.

EXPOSURES

Antineoplastic drugs following platinum-based chemotherapy and anti-PD-(L)1 treatment.

MAIN OUTCOMES AND MEASURES

Time to treatment discontinuation, progression-free survival, and overall survival were analyzed overall and by initial treatment. Exploratory subgroup analyses were stratified by patient characteristics and index treatment without adjustment for group differences.

RESULTS

In the 1793 patients (974 [54.3%] male) included in the analysis, mean (SD) age at index treatment was 67.4 (9.4) years and median time from advanced diagnosis to index treatment was 10.5 (range, 1.1-103.8) months. The most common index treatments were docetaxel plus ramucirumab (314 [17.5%]), docetaxel monotherapy (158 [8.8%]), and carboplatin plus paclitaxel (136 [7.6%]). Overall, median time from index treatment to treatment discontinuation was 3.71 (95% CI, 3.48-3.94) months; median progression-free survival, 5.29 (95% CI, 5.03-5.52) months; and median overall survival, 11.20 (95% CI, 10.48-11.93) months. In exploratory analyses, these outcomes were numerically shorter in patients who received chemotherapy monotherapy as index treatment vs the overall group; medians were numerically longer in patients who received index treatments of immuno-oncology monotherapy or chemotherapy plus immuno-oncology combination therapy.

CONCLUSIONS AND RELEVANCE

In this retrospective cohort study of patients with advanced or metastatic NSCLC, results underscored a significant need for novel treatments, including immuno-oncology combinations.