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. 2025 May 27;25(1):265.
doi: 10.1186/s12890-025-03715-9.

Real-world treatment patterns and outcomes for patients with non-metastatic non-small cell lung cancer: retrospective analyses in Canada, England, and Germany

Alastair Greystoke #  1   2 , Melinda J Daumont  3 , Caroline Rault  4 , Hannah Baltus #  5 , Philip Q Ding  6 , Gabrielle Emanuel  7 , Stefano Lucherini  8 , Lien Vo  9 , Valeria M Saglimbene  10 , Eleanor Ralphs  11 , Cátia Leal  12 , Minouk J Schoemaker  13 , Alexander Katalinic  5 , Annika Waldmann #  5 , Winson Y Cheung #  6
Affiliations

Real-world treatment patterns and outcomes for patients with non-metastatic non-small cell lung cancer: retrospective analyses in Canada, England, and Germany

Alastair Greystoke et al. BMC Pulm Med. .

Abstract

Background: Recent therapeutic advancements for non-metastatic non-small cell lung cancer (NSCLC) have increased the need for real-world baselines against which future changes in patient management and clinical outcomes can be compared.

Methods: Data on patient characteristics, initial treatment, and overall survival (OS) were derived from adult patients diagnosed with stage I-IIIC NSCLC (2010-2020) in a regional Canadian database (Oncology Outcomes [O2]), an English national registry (Cancer Analysis System [CAS]), and four regional German registries (VONKOdb) and retrospectively analyzed separately using analogous methodology.

Results: Data from 85,433 patients were analyzed. Stage at diagnosis varied, with proportions with stage I NSCLC ranging from 30.9% (VONKOdb) to 44.2% (O2) and with stage III disease from 36.9% (O2) to 48.5% (VONKOdb). Across the data sources, proportions receiving surgery ± other treatments were similar for stages I and II, but decreased through stages IIIA, IIIB, and IIIC (range, 24.7-42.7%, 4.6-21.8%, and 0.9-7.5%, respectively). Overall, 70.3-85.2% of patients received active treatment for NSCLC, with a trend toward lower proportions among those with stage III disease. Reached median OS tended to be longest in patients with resected stage I/II NSCLC (range, 28.8-128.0 months) and shortest in patients with stage IIIB/IIIC disease treated with systemic anticancer therapy (SACT) alone, radiotherapy alone, or SACT + palliative radiotherapy (range, 4.8-21.2 months).

Conclusions: These data provide insights into treatment pathways and survival outcomes before the widespread use of immunotherapy-based and targeted therapies and will serve as an important baseline for future evaluations of emerging treatments for patients with non-metastatic NSCLC.

Keywords: Database; I-O Optimise; Real-world evidence; Registries; Survival; Treatment patterns.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Each data source–specific study was conducted in accordance with the relevant Good Epidemiological Practice guidelines (the International Society for Pharmacoepidemiology Guidelines for Good Pharmacoepidemiology Practices and/or the German guidelines and recommendations for ensuring Good Epidemiological Practice [68, 69]) and the ethical principles that have their origin in the Declaration of Helsinki. Respective applicable laws and regulatory requirements in Canada, England, and Germany were followed. The O2 protocol received approval by the Health Research Ethics Board of Alberta. The CAS and VONKOdb protocols did not require ethical approval; however, the VONKOdb data extraction and analyses were approved by the Ethics Committee of the University of Lübeck (#20–483). Individual patient data were analyzed by authorized staff at each data source, with only aggregated data released to the wider study teams. Given the country-specific rules described above, and since these were non-interventional, retrospective observational studies using pseudo-anonymized patient data, informed consent was not required. Consent for publication: Not applicable. Competing interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: AG reports funding and medical writing support from Bristol Myers Squibb (BMS); consulting fees from AstraZeneca, BMS, MSD, and Roche; honoraria from AstraZeneca; support for attending meetings from Roche; and research funding (institution) from AstraZeneca. MJD reports employment by BMS at the time of these analyses, and stock or stock options in BMS. CR reports no conflicts of interest. HB reports funding and medical writing support from BMS. PQD reports no conflicts of interest. GE, SL, and LV report employment by BMS; SL and LV also report stock or stock options in BMS. VMS, ER, CL, and MJS report employment by IQVIA, a contract research organization contracted by the study sponsor, BMS. AK reports funding and medical writing support from BMS; and support for attending meetings from BMS. AW reports funding and medical writing support from BMS; and support for attending meetings from BMS. WYC reports no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study inclusion and follow-up periods. CAS, Cancer Analysis System; O2, Oncology Outcomes; VONKOdb, Oncological Health Care Research Database
Fig. 2
Fig. 2
Patient flow chart. a Exclusion criteria specific to the CAS data source. bExclusion criteria specific to the VONKOdb data source. CAS, Cancer Analysis System; NSCLC, non-small cell lung cancer; O2, Oncology Outcomes; SACT, systemic anticancer therapy; VONKOdb, Oncological Health Care Research Database
Fig. 3
Fig. 3
OS Kaplan–Meier curves for patients with stage I-IIIC NSCLC. A O2. B CAS. C VONKOdb. OS data are based on an index date of diagnosis. CAS, Cancer Analysis System; CI, confidence interval; NA, not available; NSCLC, non-small cell lung cancer; O2, Oncology Outcomes; OS, overall survival; Q, quartile; VONKOdb, Oncological Health Care Research Database
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