Temporal trends in treatment (Tx) and overall survival (OS) among patients (pts) with incident NSCLC in the UK: A real-oncology database analysis from the I-O Optimise initiative
Authors: M. Snee, S. Cheeseman, M. Thompson, M. Riaz, L. Lacoin, W. Sopwith, C. Chaib, M. Daumont, J.R. Penrod, J.C. O’Donnell, G. Hall
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, temporal trends for initial Tx and OS are reported for pts diagnosed with NSCLC at Leeds Teaching Hospitals Trust (LTHT), hosting one of the largest integrated cancer centres in the UK. Methods: A retrospective cohort study using longitudinal data collected from electronic medical records at LTHT, including all adult pts diagnosed with NSCLC from Jan 2007 to Aug 2017 (follow-up to Mar 2018). Initial Tx was the 1st Tx received after diagnosis (categorised as surgery, radiotherapy or systemic anti-cancer therapy [SACT]). In this analysis, 2 diagnostic periods were compared: 2007–2012 and 2013–2017. Kaplan–Meier methods were used for OS. Results: Among 3739 pts with incident NSCLC, TNM stage distribution was: I, 19.2% (this increased noticeably from 14.0% in 2007–2012 to 24.8% in 2013–2017); II, 11.6%; IIIA, 12.5%; IIIB, 9.0%; and IV, 47.7%. Overall, 29.7% had non-squamous cell carcinoma (NSQ), 21.9% had squamous cell carcinoma (SQ), 11.7% had NSCLC NOS (this decreased noticeably from 18.8% in 2007 to 8.4% in 2016) and 2.4% had other histology; 34.3% of pts were diagnosed without pathology. Tx patterns for NSQ and SQ pts are shown by stage and year of diagnosis (Table). Between 2007–2012 and 2013–2017, median OS (in months) increased noticeably in stage I–IIIA NSQ (28.7 to 50.0) and SQ pts (17.4 to 32.1), but not in stage IIIB–IV NSQ (4.1 to 5.0) or SQ pts (5.3 to 4.8).Table44PTemporal changes in initial Tx (within 6 months of diagnosis) by pathology, TNM stage and year of diagnosis*Data for patients with only clinical diagnosis and patients with initial treatment >6 months after diagnosis are not shown.Stage IStage IIStage IIIAStage IIIBStage IV2007-20122013-20172007-20122013-20172007-20122013-20172007-20122013-20172007-20122013-2017NSQn = 64n = 159n = 61n = 51n = 51n = 57n = 49n = 40n = 296n = 281Treatment (%)Surgery alone56.367.341.037.313.712.30.00.02.0MSurgery + SACT/RTMM21.321.69.817.50.00.0MMRT alone29.722.613.121.60.014.020.417.518.623.8SACT + RT0.00.09.8M21.633.324.530.016.217.1SACT aloneMMMM13.714.024.537.522.031.0Untreated (%)7.83.111.5M15.7M30.615.039.226.3SQn = 58n = 69n = 58n = 74n = 91n = 72n = 68n = 49n = 161n = 118Treatment (%)Surgery alone43.162.329.329.715.411.10.00.0MMSurgery + SACT/RTMM10.317.6MM0.00.0MMRT alone39.733.341.429.741.833.336.832.724.226.3SACT + RTM0.0M10.824.231.936.832.726.720.3SACT aloneM0.00.0MM11.111.814.316.821.2Untreated (%)MM13.810.813.28.314.718.429.227.1M, masked as < 5 patients; RT, radiotherapy.* Data for patients with only clinical diagnosis and patients with initial treatment >6 months after diagnosis are not shown. Open table in a new tab M, masked as < 5 patients; RT, radiotherapy. Conclusions: OS improved in stage I–IIIA pts over time, most likely due to an increased proportion diagnosed at stage I and the evolution of initial Tx through the study period. In contrast, among stage IIIB–IV pts, SACT use remains relatively low and OS outcomes remain unchanged. Future analyses will help assess the impact of new therapies, including immunotherapy and 2nd-generation tyrosine kinase inhibitors, on Tx patterns and OS in the UK. Editorial acknowledgement: Editorial assistance was provided by Richard Daniel, PhD, of Parexel and funded by Bristol-Myers Squibb. Legal entity responsible for the study: Bristol-Myers Squibb. Funding: Bristol-Myers Squibb through an EU wide RWD initiative called IO-Optimize sponsored by BMS. Disclosure: M. Snee: Grants, personal fees: IQVIA, during the conduct of the study. L. Lacoin: Consultant epidemiologist contracted by Bristol-Myers Squibb. W. Sopwith: Personal fees: IQVIA, during the conduct of the study and outside the submitted work. C. Chaib: Employee: Bristol-Myers Squibb; Bristol-Myers Squibb (BMS) is funding this work through an EU wide RWD initiative called IO-Optimize sponsored by BMS. J.R. Penrod: Employment, stock ownership: Bristol-Myers-Squibb. J.C. O'Donnell: Employee, shareholder: BMS. All other authors have declared no conflicts of interest.