Survival of U.S. Medicare patients with advanced non-small cell lung cancer by line of therapy.

Abstract

6582 Background: Prior real-world (RW) studies of advanced non-small cell lung cancer (adv NSCLC) have described overall survival (OS) from diagnosis (Dx) for all patients (pts) as well as separately by whether chemotherapy was received. More recently, innovations in systemic anti-cancer treatment (SATx) have expanded to include oral targeted agents. Current RW data on OS of advanced pts in the US are limited, particularly by line of therapy (LOT). In this study, we use data from a recent cohort of SEER-Medicare pts to examine OS from adv NSCLC Dx for all pts and separately by SATx status. For treated pts, we also describe OS from initiation of each LOT. Methods: Fee-for-service pts aged ≥66 enrolled in Medicare Parts A/B/D with an incident Dx of adv NSCLC (Stage IIIB/IV) during 2007–9 were identified in the SEER-Medicare linked database. OS follow-up was available through 12/31/2011. We examined demographic and clinical characteristics, including histology, and the receipt of SATx (chemotherapy, tyrosine kinase inhibitors, or monoclonal antibodies). We performed descriptive and Kaplan Meier (KM) analysis of OS from adv NSCLC Dx for all pts and separately by receipt of SATx. KM OS analysis by LOT was performed from date of treatment initiation. Results: Of 7,080 eligible pts, 26% had squamous, 51% had nonsquamous, and 24% had not otherwise specified histology; 28% of pts were Stage IIIB and 72% were Stage IV. Overall, 44% of pts received SATx. For all pts, median OS from Dx was 4.9 months, and 1- and 2-year OS rates were 23% and 7%, respectively (Table). Median OS from adv NSCLC Dx was 2.8 months for pts not receiving SATx and 9 months for pts receiving SATx (P<.0001). From initiation of each LOT, OS declined with each successive line, with median OS of 6.6, 5.9, and 5.3 months for 1L, 2L, and 3L, respectively. Conclusions: Despite advances in SATx for adv NSCLC, more than half of RW pts do not receive such treatment and outcomes for both treated and untreated pts remain poor, with fewer than 10% of pts alive at 2 years following Dx or initiation of SATx. OS of adv NSCLC pts. N (%) Median OS (months) 1-yr OS, % 2-yr OS, % All pts 7,080 (100) 4.9 23 7 SATx (from adv Dx) Yes 3,131 (44) 9.0 37 11 No 3,949 (56) 2.8 11 3 LOT 1L 3,113 (44) 6.6 28 8 2L 1,320 (19) 5.9 25 7 3L 535 (8) 5.3 21 5

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Affiliated Institutions

• University of North Carolina at Charlotte US
• Mount Sinai Hospital US
• Bristol-Myers Squibb (United States) US
• Icahn School of Medicine at Mount Sinai US
• IQVIA (United States) US

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