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. 2023 Jan 13;23(1):16.
doi: 10.1186/s12890-022-02288-1.

Evolution of treatment patterns and survival outcomes in patients with advanced non-small cell lung cancer treated at Frankfurt University Hospital in 2012-2018

Andrea Wolf  1 , Jan A Stratmann  2 , Shabnam Shaid  2 , Nicolas Niklas  3 , Alan Calleja  4 , Harveen Ubhi  4 , Robin Munro  4 , Daniela Waldenberger  5 , Robert Carroll  6 , Melinda J Daumont  7 , John R Penrod  8 , Laure Lacoin  9 , Gernot Rohde  10
Affiliations

Evolution of treatment patterns and survival outcomes in patients with advanced non-small cell lung cancer treated at Frankfurt University Hospital in 2012-2018

Andrea Wolf et al. BMC Pulm Med. .

Abstract

Background: Immune checkpoint inhibitors (ICIs) have improved outcomes for patients with advanced non-small cell lung cancer (NSCLC) versus chemotherapy in clinical trials. In Germany, ICIs have been used clinically since 2015 for patients with advanced/metastatic NSCLC without epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase (ALK) aberrations. As part of I-O Optimise, a multinational research program utilizing real-world data on thoracic malignancies, we describe real-world treatment patterns and survival following reimbursement of ICIs for advanced NSCLC in Germany.

Methods: This retrospective cohort study included patients with locally advanced/metastatic NSCLC without known EGFR/ALK aberrations who received a first line of therapy at Frankfurt University Hospital between January 2012 and December 2018, with follow-up to December 2019 or death, whichever occurred first. Using electronic medical records, treatment patterns and survival outcomes were described by histology (squamous cell [SQ]; non-squamous cell [NSQ]/other) and time period (pre- and post-ICI approval).

Results: Among eligible patients who started first-line treatment, 136 (pre-ICI) and 126 (post-ICI) had NSQ/other histology, and 32 (pre-ICI) and 38 (post-ICI) had SQ histology. Use of an ICI in the NSQ/other cohort increased from 5.9% (all second- or third-line) in the pre-ICI period to 57.1% (22.2% in first-line, including 13.5% as monotherapy and 8.7% combined with chemotherapy) in the post-ICI period. This was paralleled by a significant (P < 0.0001) prolongation of median (95% CI) OS from 9.4 (7.1-11.1) to 14.8 (12.7-20.5) months between the pre-ICI and post-ICI periods. A similar increase in the uptake of ICI was observed for the SQ cohort (from 3.1% pre-ICI [fourth-line] to 52.6% post-ICI [28.9% as first-line, including 15.8% as monotherapy and 13.2% combined with chemotherapy]); however, analysis of survival outcomes was limited by small group sizes.

Conclusion: These real-world data complement clinical trial evidence on the effectiveness of ICIs in patients with advanced NSCLC and NSQ/other histology in Germany.

Keywords: Immune checkpoint inhibitors; Immunotherapy; Non-small cell lung cancer; Overall survival; Real-world evidence.

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Conflict of interest statement

AW reports no conflicts of interest. JAS reports personal fees from Boehringer Ingelheim, AstraZeneca, Roche, Bristol Myers Squibb, Amgen, LEO Pharma, Novartis, and Takeda outside of the submitted work. SS reports no conflicts of interest. NN, AC, HU, and RM are employees of IQVIA. DW, RC, MJD, and JRP are employees of Bristol Myers Squibb; RC and JRP also report stock ownership in Bristol Myers Squibb. LL is an employee of Epi-Fit and was contracted (paid) as a consultant by Bristol Myers Squibb to support the I-O Optimise initiative. GR reports personal fees from AstraZeneca, Berlin Chemie, Bristol Myers Squibb, Boehringer Ingelheim, Chiesi, Essex Pharma, Grifols, GSK, Insmed, MSD, Roche, Solvay, Takeda, Novartis, Pfizer, and Vertex for consultancy during advisory board meetings and personal fees from AstraZeneca, Berlin Chemie, Bristol Myers Squibb, Boehringer Ingelheim, Chiesi, Essex Pharma, Grifols, GSK, Insmed, MSD, Roche, Solvay, Takeda, Novartis, Pfizer, and Vertex for lectures including service on speakers’ bureaus.

Figures

Fig. 1
Fig. 1
First-line treatment regimens received in the pre-ICI and post-ICI periods by histology. a Patients who discontinued a platinum-based chemotherapy and initiated an ICI other than pembrolizumab without any progression reported prior to ICI start. Under these circumstances, the ICI was considered as part of the first-line regimen. b ICI monotherapy other than pembrolizumab (i.e., not indicated in first line); patients in this category were likely to have been refractory to a previous multimodal treatment administered for non-metastatic disease. ALK Anaplastic lymphoma kinase, EGFR Epidermal growth factor receptor, ICI Immune checkpoint inhibitor; NSQ Non-squamous cell, SQ Squamous cell, TKI Tyrosine kinase inhibitor
Fig. 2
Fig. 2
Second-line treatment regimens received by patients with NSQ/other histology in the pre-ICI and post-ICI periods. a Other treatments included cabozantinib (n = 1) and capmatinib (n = 2) in the pre-ICI period and dabrafenib plus trametinib (n = 1) in the post-ICI period. EGFR Epidermal growth factor receptor, ICI Immune checkpoint inhibitor, NSQ Non-squamous cell, TKI Tyrosine kinase inhibitor
Fig. 3
Fig. 3
Overall survival for patients with NSQ/other (A) or SQ (B) histology receiving a first line of therapy in the pre-ICI and post-ICI periods. Index date represents the start of first-line therapy. CI Confidence interval, ICI Immune checkpoint inhibitor, NSQ Non-squamous cell, OS Overall survival, SQ Squamous cell
Fig. 4
Fig. 4
Overall survival for patients with NSQ/other histology receiving first-line platinum-based therapy in the pre-ICI and post-ICI periods. Includes only those patients receiving a first-line platinum-based chemotherapy regimen alone (i.e., no ICI therapy in first-line setting). Index date represents the start of first-line therapy. CI Confidence interval, ICI Immune checkpoint inhibitor, NSQ Non-squamous cell, OS Overall survival
Fig. 5
Fig. 5
Overall survival for patients with NSQ/other histology receiving a second line of therapy in the pre-ICI and post-ICI periods. Index date represents the start of second-line therapy. CI Confidence interval, ICI Immune checkpoint inhibitor, NSQ Non-squamous cell, OS Overall survival
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