Applied first-line systemic treatments, treatment modifications and outcomes in non-oncogenic metastatic non-small cell lung cancer in the Netherlands in 2019–2020: A nationwide study

Abstract

Background: The treatment landscape for patients with metastatic non-small cell lung cancer (mNSCLC) is rapidly evolving as new therapies are continually introduced. This study aimed to provide a contemporary overview of how patients diagnosed with mNSCLC in the Netherlands are treated in routine clinical practice, how applied systemic treatments are tolerated and with which overall survival (OS). Methods: This nationwide retrospective study utilised data from the Netherlands Cancer Registry (NCR) complemented by electronic health records data of patients diagnosed with stage IV non-oncogenic mNSCLC in the years 2019–2020. First-line (1 L) treatments and corresponding overall survival (OS) were identified and compared across hospital types (academic, teaching, general), along with a multivariable analysis of 1 L treatment, patient, and tumour characteristics. In a subset of seven teaching hospitals, dose adjustments, early discontinuations and follow-up treatments were also assessed together with ESMO guideline adherence based on ECOG scores and levels of PD-L1 tumour expression. Results: The total sample comprised 9511 patients (56 % male and mean age 68 years) of which 4485 (47 %) received best supportive care (BSC) only. The most frequently applied 1 L systemic treatment was chemo-immunotherapy with 51 % one-year survival. Starting any 1 L systemic treatment was more frequent among patients with younger age, better performance status, PD-L1 > 50 %, and those with their diagnosis established in an academic hospital. Chemotherapy was discontinued early (<4 cycles) in 46 % of patients with 1 L chemotherapy and 34 % of patients with chemo-immunotherapy. Guideline adherence was highest in patients with ECOG1 and PD-L1 1–49 % (76 %) and lowest in the ECOG > = 2 and PD-L1 1–49 % group (30 %). Conclusions: Best supportive care over systemic treatment and chemotherapy treatment modifications are common in patients with mNSCLC. Presenting information to patients about these outcomes can support shared-decision making.