Background: Molecular testing is recommended to guide treatment for patients with metastatic non-small cell lung cancer (mNSCLC). For patients without AGAs, initial treatment with platinum chemotherapy (plat) and/or immune-oncology (IO) agents is the standard of care (SOC). However, there is little real-world data on subsequent treatment (sTx) after plat and IO discontinuation. This study characterized sTx in mNSCLC patients without AGAs in US community oncology practices. Methods: This was a retrospective study of adult mNSCLC patients diagnosed between 1/2017 and 12/2019 with follow-up through 12/2020. Data were collected from The US Oncology Network electronic health records (EHR) and supplemented by patient chart review. Patients were required to have no known AGAs (negative for EGFR, ALK, ROS1, BRAF, NTRK, MET, and/or RET, or no documented genomic testing). Kaplan Meier analysis was used to estimate median time to discontinuation (mTTD), progression-free survival (mPFS) and overall survival (mOS). Results: Among 11,194 patients without AGAs identified in the EHR, 400 charts were randomly selected. Of these, eligibility was confirmed in 370 patients and 292 received systemic treatment in the metastatic setting [plat+IO-based (34.6%), plat-based (32.2%), IO-based (29.5%) and other (3.7%) as first line treatment]. A total of 173 patients received plat and IO either concurrently or sequentially. Among these patients, 55 received sTx following treatment with plat and IO [median age 70 years, 52.7% female, and 65.5% ≥2 metastatic sites]. Median study follow-up from sTx initiation to end of study was 17.9 months. Non-plat chemotherapy (56.4%) was the most common sTx, followed by IO only (20%), plat-based regimen ± IO (14.5%), and other agents (9.1%). The most common non-plat chemotherapy agent was docetaxel (n=16) and few patients received with ramucirumab (n=3). For all sTx, mTTD, mPFS and mOS were 3.6, 4.4 and 13.5 months, respectively. The most common reasons for sTx discontinuation were disease progression (32.7%), toxicity (27.3%) and hospice care (25.5%). Conclusions: Non-plat chemotherapy was the most common therapy following plat and IO discontinuation in the community oncology setting. Treatment duration, mPFS and mOS observed in the real-world setting were relatively short and in-line with prior clinical trials. There remains unmet need for more effective treatments in salvage setting after plat and IO therapy in patients with mNSCLC and no AGAs.
HSR22-141 Table 1. Clinical Outcomes by Subsequent Treatment
*Other sTx group not shown due to small sample size