Real-world treatment and survival of patients with advanced non-small cell lung Cancer: a German retrospective data analysis

Abstract

Background: The objective of this study was to describe the real-world treatment and overall survival (OS) of German patients with a diagnosis of advanced non-small cell lung cancer (aNSCLC), and to explore factors associated with the real-world mortality risk.

Methods: This was a retrospective German claims data analysis of incident aNSCLC patients. Data were available from 01/01/2011 until 31/12/2016. Identification of eligible patients took place between 01/01/2012-31/12/2015, to allow for at least 1-year pre-index and follow-up periods. Inpatient and outpatient mutation test procedures after aNSCLC diagnosis were observed. Further, prescribed treatments and OS since first (incident) aNSCLC diagnosis and start of respective treatment lines were described both for all patients and presumed EGFR/ALK/ROS-1-positive patients. Factors associated with OS were analyzed in multivariable Cox regression analysis.

Results: Overall, 1741 aNSCLC patients were observed (mean age: 66·97 years, female: 29·87%). The mutation test rate within this population was 26·31% (n = 458), 26·6% of these patients (n = 122) received a targeted treatment and were assumed to have a positive EGFR/ALK/ROS-1 test result. Most often prescribed treatments were pemetrexed monotherapy as 1 L (21·23% for all and 11·11% for mutation-positive patients) and erlotinib monotherapy as 2 L (25·83%/38·54%). Median OS since incident diagnosis was 351 days in all and 571 days in mutation-positive patients. In a multivariable Cox regression analysis, higher age, a stage IV disease, a higher number of chronic drugs in the pre-index period and no systemic therapy increased the risk of early death since first aNSCLC diagnosis. On the other hand, female gender and treatment with therapies other than chemotherapy were associated with a lower risk of early death.

Conclusions: Despite the introduction of new treatments, the real-world survival prognosis for aNSCLC patients remains poor if measured based on an unselected real-world population of patients. Still, the majority of German aNSCLC patients do not receive a mutation test.

Keywords: Advanced NSCLC; Mutation testing; Non-small cell lung cancer; Overall survival.

Fig. 1

Patient attrition chart. Outlines the patient selection steps along with the patient numbers included and excluded at each step

Fig. 2

Mutation testing and observed treatment patterns over time. Describes based on all patients who received at least a 1 L treatment, distribution of mutation tests and treatment patterns over time. Treatments were divided into targeted treatments and non-targeted treatments including immunotherapy

Fig. 3

Kaplan Meier OS analysis, from date of incident aNSCLC diagnosis. Shows the Kaplan Meier survival estimates from incident aNSCLC diagnosis for the overall aNSCLC patient sample as well as for subgroups based on mutation testing and received treatments. For assignment of patients to treatments, line of therapy did not matter. Log-rank test: Chemotherapy only/No therapy: p = 0.001; Chemotherapy only/Mutation positive & targeted therapy: p < 0.001; Chemotherapy only/Immunotherapy only p < 0.001; Chemotherapy only/No mutation test & targeted therapy: p = 0.006

Fig. 4

Kaplan Meier OS analysis, from date of incident aNSCLC diagnosis by 1 L treatment type. Shows the Kaplan Meier survival estimates from incident aNSCLC diagnosis for the overall aNSCLC patient sample as well as for subgroups based on mutation testing and received 1 L treatments. Log-rank test: Chemotherapy/Mutation positive & targeted therapy: p = 0.011; Chemotherapy/Immunotherapy only p = 0.002; Chemotherapy/No mutation test & targeted therapy: p = 0.570

Fig. 5

Multivariate Cox regression analysis of factors associated with early death, since date of incident aNSCLC diagnosis. Shows the results of a multivariable Cox regression analysis exploring predictors of early death. Variables initially included but excluded due to their insignificance were positive mutation status and hospitalizations in pre-index period