Treatment Sequencing Varies Significantly Among Lung Cancer Patients

By Michael Vlessides, /alert Contributor
Save to PDF By

Patients with advanced non small-cell lung cancer (NSCLC) are subject to a variety of treatment patterns and drug-sequencing options, according to a new study using real-world data. 

Investigators from the Icahn School of Medicine at Mount Sinai in New York, NY concluded that with treatment algorithms of advanced NSCLC continuing to evolve, such variability warrants further investigation to help clinicians provide optimal treatment. 

In a recent meeting presentation, the researchers noted that while optimal sequencing of systemic therapy in advanced NSCLC is vital to achieving maximal clinical benefit, it is practically challenging to study such sequencing through clinical trials. 


Treatment sequencing. Source: Getty

Such shortcomings did not stop the investigators from performing the study, however.

“Real-world data allow retrospective, observational studies to examine treatment patterns and associated clinical outcomes,” they wrote. 

The data came from a cohort of 1,609 individuals with advanced NSCLC, all of whom received systemic therapies at Mount Sinai hospitals. These patients were analyzed for a variety of endpoints, including the number of lines of therapy, type of therapeutic modality (chemotherapy, targeted therapy, and immunotherapy), and the sequence in which treatments were given when the line of therapy exceeded one. 

The investigators used time to therapy discontinuation as a surrogate clinical endpoint for patient outcomes. 

The analysis found that 578 of the 1,609 patients (36%) received more than one line of therapy. Of these, 356 patients (22%) received tyrosine kinase inhibitors, and 297 (16%) received immune checkpoint inhibitors. 

Kaplan-Meier analysis revealed that among the 297 patients who received immune checkpoint inhibitors, the median time to discontinuation of therapy was longer in the first-line setting (295 days; 95% CI: 169-523 days; n=132) than when the agent was used as a second or later line of therapy (169 days; 95% CI: 113-269 days; n=165). Nevertheless, this difference was not statistically significant (p=0.092). 

The study also revealed no difference in time to therapy discontinuation for patients on tyrosine kinase inhibitors, whether the agents were used as first or subsequent lines of therapy (P = .51). With respect to therapy sequencing, when patients received tyrosine kinase inhibitors as the first line of therapy (n=94), 60% of them received another TKI, 35% received chemotherapy, and 5% received an immune checkpoint inhibitor as the second line of therapy. 

When the researchers examined the 370 patients who progressed on first-line platinum-based chemotherapy, they found that 52% received another chemotherapeutic regimen, 32% received a regimen containing a checkpoint-inhibitor, and 16% received a targeted therapy as the second line of therapy. 

Interestingly, these percentages were found to shift significantly toward more immune checkpoint inhibitors (24%, 66%, and 10% for chemotherapy, immune checkpoint inhibitors, and targeted therapy, respectively) when only 2016-2018 data were examined. 

In the second-line setting after platinum therapy, time to discontinuation of therapy was significantly longer in the immune checkpoint inhibitor group (332 days; 95% CI: 169-484 days) than it was for the chemotherapy group (88 days; 95% CI: 65-100 days; P < .0001). These results, they said, are consistent with results from ‘pivotal clinical trials’. 

Given the wide therapeutic diversity observed in the trial, the investigators called for more research in the field. “Various treatment sequences may impact patient outcomes, and therefore warrant further investigation,” they wrote.

 

© 2024 /alert® unless otherwise noted. All rights reserved.
Reproduction in whole or in part without permission is prohibited.
Privacy Policy | Terms of Use | Editorial Policy | Advertising Policy