Treatment (Tx) patterns and overall survival (OS) in patients (pts) with NSCLC in Sweden: A SCAN-LEAF study analysis from the I-O Optimise initiative
Authors: S. Ekman, J.B. Sørensen, O.T. Brustugun, P. Horvat, D. Patel, M. Rosenlund, A. Mette Kejs, A. Juarez-Garcia, M. Daumont, L. Lacoin, J.R. Penrod, J.C. O’Donnell, M. Planck
Journal: Annals of Oncology (2019)

Background: As part of I-O Optimise, a multinational research platform providing real-world insights into the management of lung cancers, the SCAN-LEAF study aims to describe the epidemiology, clinical care and outcomes for pts with NSCLC in Scandinavia. We report initial Tx and OS for pts with NSCLC prior to the availability of immunotherapies in Sweden.Table47PInitial Tx following diagnosis (≤6 months) based on TNM stage and year of diagnosis*Data shown for 2244 pts receiving Tx within 6 months of diagnosis. Data for pts with initial Tx administered more than 6 months after diagnosis or who did not have a valid TNM stage are not shown., %Stage IStage IIStage IIIAStage IIIBStage IV2012–201420152012–201420152012–201420152012–201420152012–20142015NSQn = 263n = 100n = 97n = 32n = 136n = 61n = 67n = 29n = 736n = 267Surgery only52.950.027.815.68.83.30.00.00.30.0Surgery + SACT or RT6.57.025.843.810.316.40.00.00.40.8RT alone27.022.012.418.811.83.317.910.318.613.5Chemoradiation3.43.020.69.452.259.00.00.00.00.0SACT + RT in stage IIIB–IV0.00.00.00.00.00.038.837.920.516.9SACT alone2.73.06.26.38.19.823.931.037.646.8Not treated**No record of surgery, RT, or SACT during follow-up.7.615.07.26.38.88.219.420.722.622.1SQn = 65n = 19n = 35n = 18n = 60n = 31n = 44n = 23n = 123n = 38Surgery only44.636.825.716.73.33.20.00.00.80.0Surgery + SACT or RT7.75.314.316.810.16.50.04.30.00.0RT alone36.931.628.650.011.712.920.521.719.510.5Chemoradiation3.15.320.05.650.051.60.00.00.00.0SACT + RT in stage IIIB–IV0.00.00.00.00.00.038.747.813.021.1SACT alone3.110.55.711.111.76.527.38.734.144.7Not treated**No record of surgery, RT, or SACT during follow-up.4.610.55.70.013.319.413.617.432.523.7RT, radiotherapy; TNM, tumour, nodes, and metastasis.* Data shown for 2244 pts receiving Tx within 6 months of diagnosis. Data for pts with initial Tx administered more than 6 months after diagnosis or who did not have a valid TNM stage are not shown.** No record of surgery, RT, or SACT during follow-up. Open table in a new tab RT, radiotherapy; TNM, tumour, nodes, and metastasis. Methods: The analysis includes all adult pts diagnosed with NSCLC at Uppsala and Karolinska (Stockholm) University Hospitals from 2012 to 2015 (follow-up to Dec 2016). Electronic medical record data were extracted using Pygargus CXP software and linked with national registries. Bespoke rule-based algorithms were applied to describe Tx patterns; Kaplan–Meier methods were used to estimate OS. Results: 2779 pts were diagnosed with incident NSCLC (median age, 70 yrs [range: 22–96; 14.2% ≥80]; male, 48.5%; histology: non-squamous (NSQ), 70.9%, squamous (SQ), 17.7%, other, 11.4%; stage distribution: I, 19.3%; II, 7.7%; IIIA, 12.3%; IIIB, 7.2%; IV, 51.2%). Initial Tx (≤6 months from diagnosis) by stage and yr of diagnosis is shown in the table. Median OS (months) for NSQ and SQ pts: not reached and 52.8 in stage I, 43.2 and 23.6 in stage II, 26.7 and 20.4 in stage IIIA, 12.5 and 12.9 in stage IIIB, and 7.6 and 6.1 in stage IV, respectively. Among stage IIIB–IV pts, 60.7% (NSQ) and 53.5% (SQ) had ≥1 line of systemic anti-cancer therapy (SACT); median OS was 12.2 (NSQ) and 10.4 (SQ) months in pts on SACT, and 3.1 (NSQ) and 3.7 (SQ) months in pts not on SACT. Ongoing analyses will assess factors associated with SACT receipt in stage IIIB–IV pts. Conclusions: Swedish pts with NSCLC had a high burden of disease, with most diagnosed at stage IV and a median OS of 1 yr in late-stage pts receiving SACT. There is also scope for improved prognosis in pts diagnosed at early stages, particularly in SQ pts. Future analyses will assess the potential impact of recent improvements in diagnostics and therapeutics on Tx patterns and OS in Swedish NSCLC pts. Editorial acknowledgement: Professional medical writing assistance was provided by Richard Daniel, PhD, of Parexel funded by Bristol-Myers Squibb. Legal entity responsible for the study: Bristol-Myers Squibb. Funding: Bristol-Myers Squibb. Disclosure: S. Ekman: Grants: BMS, during the conduct of the study. P. Horvat, A. Mette Kejs: Employee: IQVIA. D. Patel: Personal fees: BMS, during the conduct of the study. M. Rosenlund: Employed: BMS, during the conduct of the study. A. Juarez-Garcia: Employed: BMS, outside the submitted work. L. Lacoin: Consultant epidemiologist contracted by Bristol-Myers-Squibb for the SCAN-LEAF Project. All other authors have declared no conflicts of interest.