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. 2019 Nov;11(11):4474-4483.
doi: 10.21037/jtd.2019.11.11.

Safety outcomes in advanced non-small-cell lung cancer patients treated with first-line platinum-based regimens in the United States

Lei Chen  1 , Jong Seok Kim  1 , Belen San Antonio  2 , Yajun Emily Zhu  1 , Lucy Mitchell  3 , William John  1
Affiliations

Safety outcomes in advanced non-small-cell lung cancer patients treated with first-line platinum-based regimens in the United States

Lei Chen et al. J Thorac Dis. 2019 Nov.

Abstract

Background: We analyzed the treatment patterns and safety outcomes of the most common first-line platinum-based regimens initiated on or after non-small cell lung cancer (NSCLC) diagnosis in a real-world setting.

Methods: Based on a United States oncology electronic medical record (EMR) database, patients treated with first-line platinum-based regimens after advanced NSCLC diagnosis from September 2008 to November 2014 were analyzed. Baseline characteristics and selected adverse events during treatment [incidence proportions and incidence rates (IRs)] were described by regimen. Propensity score stratification was used to adjust for baseline characteristics differences. Hazard ratios (HRs) were estimated using Cox proportional hazards model, with paclitaxel (Pac)/carboplatin (Carbo) as reference. Subgroup analysis was conducted for elderly patients (≥70 years old).

Results: The most common five regimens for the eligible patients were as follows: Pac/Carbo (n=3,009), pemetrexed (Pem)/Carbo (n=1,625), Pem/Carbo/bevacizumab (Bev) (n=735), Pac/Carbo/Bev (n=531), Pem/cisplatin (Cis) (n=357), and docetaxel (Doc)/Carbo (n=355). Highest IRs were reported for anemia, neutropenia, nausea, and vomiting across these regimens in patients of all ages. After propensity score stratification, compared with Pac/Carbo, risk of anemia was significantly lower with Pac/Carbo/Bev (HR =0.67), Pem/Cis (HR =0.68), and Pem/Carbo/Bev (HR =0.82); risk of neutropenia was comparable among all regimens except Doc/Carbo (significantly lower risk; HR =0.72); and risk of nausea (HR =1.45) and vomiting (HR =1.50) was significantly higher with Pem/Cis. Safety outcomes in elderly patients were consistent with the overall population.

Conclusions: While EMR data have limitations, the real-world safety outcome with individual chemotherapy regimen could be considered for the better selection of platinum-based therapies in NSCLC.

Keywords: Chemotherapy; elderly patients; non-small cell lung cancer (NSCLC); real-world setting; safety profile.

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Conflict of interest statement

Conflicts of Interest: L Chen, JS Kim, B San Antonio, YE Zhu, L Mitchell, W John are current/former employees and own stock in Eli Lilly and Company.

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