Patient Characteristics, Testing and Treatment Patterns, and Outcomes in EGFR-Mutated Advanced Non-Small Cell Lung Cancer: A Multinational, Real-World Study

Abstract

Introduction: Treatment landscape for advanced/metastatic NSCLC (aNSCLC) has evolved considerably over the past few decades with the advent of targeted therapies for epidermal growth factor receptor-mutated (EGFRm+) aNSCLC treatment. This study described real-world patient and disease characteristics, treatment and practice patterns, and clinical, economic, and patient-reported outcomes (PROs) in patients with EGFRm+ aNSCLC.

Methods: Data were derived from the Adelphi NSCLC Disease Specific Programme™ (DSP™), a point-in-time survey conducted between July and December 2020. The survey included oncologists and pulmonologists, and their consulting patients (with physician-confirmed EGFRm+ aNSCLC) from nine countries: the US, Brazil, the UK, Italy, France, Spain, Germany, Japan, and Taiwan. All analyses were descriptive.

Results: Overall, 542 physicians reported data for 2857 patients (mean age 65.6 years), and most patients were female (56.0%), white (61.0%), and had stage IV disease at initial diagnosis (76.0%), and adenocarcinoma histology (89.0%). Most patients received EGFR-tyrosine kinase inhibitors (TKI) therapy in first- (91.0%), second- (74.0%), and third-line (67.0%). The most common tumor samples and methods for EGFR detection were EGFR-specific mutation detection tests (44.0%) and core needle biopsy (56.0%). Median time to next treatment was 14.0 (IQR 8.0-22.0) months and disease progression was the main physician-reported reason for early discontinuation. The most common physician-reported disease symptoms were cough (51.0%), fatigue (37.0%), and dyspnea (33.0%). In patients assessed for PROs, mean EQ-5D-5L index and FACT-L health utility scores were 0.71 and 83.5, respectively. On average, patients lost 10.6 h of work/week for approximately 29.2 weeks due to EGFRm+ aNSCLC.

Conclusion: This real-world multinational data set showed that most patients with EGFRm+ aNSCLC were treated per the country relevant clinical guidelines, with progression as the main reason for early treatment discontinuation. For the included countries, these findings may offer a useful benchmark for decision makers to determine future allocation of healthcare resources for patients with EGFRm+ aNSCLC.

Keywords: Advanced non-small cell lung cancer; Disease Specific Programme™; EGFR mutation; Patient-reported outcomes; Point-in-time; Real-world; Survey; Treatment patterns.

Fig. 1

Tumor staging at different time points: overall population. All data are presented as %. 1L first line, aNSCLC advanced non-small cell lung cancer

Fig. 2

Treatment patterns: overall population and by country. a 1L. b 2L and 3L. All data are presented as %. 1L first line, 2L second line, 3L third line, BR Brazil, BSC best supportive care, DE Deutschland, ES Spain, EU5 5 countries from the European Union, FR France, IT Italy, JP Japan, TW Taiwan, UK United Kingdom, US United States

Fig. 3

Treatment combinations: overall population. All data are presented as %. 1L first line, 2L second line, 3L third line, BSC best supportive care

Fig. 4

Response rates after end of treatment: overall population. All data are presented as %. 1L first line, 2L second line, 3L third line, FR full response, NR no response, PR partial response

Fig. 5

Types of tests performed for diagnosis and monitoring: overall population. All data are presented as %. CT computed tomography, FDG-PET fluorodeoxyglucose-positron emission tomography, MRI magnetic resonance imaging