Abstract 4227: Treatment regimens, treatment duration, and between-treatment duration in patients with small cell lung cancer across lines of therapy: An analysis of electronic health records data
Authors: Jiang Rui , Gulbranson Scott H. , Komarnitsky Philip , Koch Martina M. , Lievano Fabio A. , Potluri Ravi , Scripture Charity , Tyczynski Jerzy E. 
Published: August 2018

While platinum-based combination chemotherapy is recommended for first-line treatment of small cell lung cancer (SCLC), the treatment for relapsed and refractory SCLC is heterogeneous with limited clinical benefit. Topotecan is the only approved second-line agent, and no drug or combination regimen is approved in the third- or later line settings. The purpose of this study was to describe treatment regimens, treatment duration, and between treatment duration in SCLC patients across lines of therapy (LOT) in recent clinical practice. We analyzed treatment patterns in 8,291 SCLC patients who had a diagnosis between 01/01/2008 and 09/30/2016 and met our inclusion criteria using Optum's electronic health records (EHR) database. The database consists of de-identified, patient-level EHR data from a network of healthcare provider organizations in the United States. Of these 8,291 newly diagnosed patients, 3,633, 1,211, 428, 138, 45, 17, 5, 1 patients received the first-, second-, third-, fourth-, fifth-, sixth-, seventh- and eighth- line of therapy, respectively. Platinum-based chemotherapy (carboplatin or cisplatin) plus etoposide was the most frequently administered first-line treatment (51%+29%=80%) in SCLC (Table 1). Cisplatin has been largely replaced by the less toxic carboplatin after first line therapy. The most frequent second-line treatments were topotecan and carboplatin+etoposide. Topotecan, paclitaxel, gemcitabine, docetaxel, and carboplatin+etoposide were the most frequently administered chemotherapy drugs in third or later lines. As the disease progressed/became more severe, time to subsequent LOT decreased with increasing number of therapy lines (Table 1). In conclusion, this analysis provides valuable insight into real-world SCLC treatment characteristics, particularly for later lines, and indicates a need for more effective novel therapies for SCLC.

Table 1. Regimens, treatment duration, and between treatment duration across lines of therapy (LOT)LOT1 (N=3,633)LOT2 (N=1,211)LOT3 (N=428)LOT4+ (N=206)Carboplatin+Etoposide51%21%7%10%Cisplatin+Etoposide29%5%1%0%Topotecan2%31%29%13%Carboplatin+Paclitaxel5%4%5%2%Etoposide4%4%3%4%Paclitaxel1%8%18%13%Gemcitabine0%2%7%15%Irinotecan0%4%4%5%Carboplatin2%2%0%0%Docetaxel0%2%7%10%Carboplatin+Pemetrexed2%0%0%0%Nivolumab0%3%4%6%Carboplatin+Irinotecan0%3%3%4%Pemetrexed0%3%2%1%Cisplatin+Irinotecan0%2%2%1%Cisplatin1%1%0%0%Cyclophosphamide+Doxorubicin+Vincristine0%1%3%5%Carboplatin+Gemcitabine1%1%1%1%Other regimens2%3%4%7%Treatment durationMean (SD), DaysLOT160.8 (47.7)LOT256.2 (67.8)LOT354.7 (69.1)LOT452.5 (54.1)LOT564.5 (111)LOT628.5 (30.1)LOT768.4 (55.9)LOT836 (0)Duration between LOTsLOT1 to LOT2199 (165)LOT2 to LOT3149 (131)LOT3 to LOT4134 (131)LOT4 to LOT5139 (97.8)LOT5 to LOT6125 (88.7)LOT6 to LOT791.4 (34.9)LOT7 to LOT8201 (0)

Citation Format: Rui Jiang, Scott H. Gulbranson, Philip Komarnitsky, Martina M. Koch, Fabio A. Lievano, Ravi Potluri, Charity Scripture, Jerzy E. Tyczynski. Treatment regimens, treatment duration, and between-treatment duration in patients with small cell lung cancer across lines of therapy: An analysis of electronic health records data [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4227.