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Abstract
Objectives:
SELECTTION was a multinational, prospective observational study to assess the choice of and the time from initiation of second-line treatment to treatment discontinuation for any reason in patients with non-small cell lung cancer.
Methods:
Treatment cohorts were constructed based on prescribed second-line treatments that were at the discretion of the treating physicians, for 1013 patients enrolled in 11 countries. Propensity score analysis was conducted to assess whether the cohorts were comparable. Time from initiation of second-line treatment to treatment discontinuation was the primary endpoint. Reasons for treatment discontinuation, overall survival, progression-free survival and choice of second-line treatment were secondary endpoints.
Results:
The treatment cohorts were pemetrexed (46.2%), docetaxel (22.9%), erlotinib (20.4%) and other treatments (10.5%). Analyses of baseline data and propensity scores showed that the erlotinib cohort comprised substantially different patients compared with the pemetrexed and docetaxel cohorts: patients in the erlotinib cohort were more likely to be women, never-smokers, have adenocarcinoma and worse performance status. Therefore, comparisons of outcomes between cohorts were not appropriate. Although disease progression was the most common reason for treatment discontinuation in all cohorts, erlotinib patients tended to continue treatment after disease progression, whereas in the docetaxel and pemetrexed cohorts, discontinuation occurred soon after disease progression.
Conclusions:
In real-world clinical practice the profiles of patients assigned to erlotinib were distinctly different from those assigned to pemetrexed or docetaxel. The most common reason for treatment discontinuation was progressive disease, reflecting adherence to clinical recommendations. It is difficult to extrapolate these findings to the present, as both clinical practice and the approved indications for NSCLC treatments have evolved substantially.
Transparency
Declaration of funding
This study was sponsored by Eli Lilly and Company. The sponsors were involved in the design of the study, data collection, analysis and interpretation, the development of this manuscript, and the decision to submit the manuscript for publication in CMRO.
Declaration of financial/other relationships
C.V-G. and K.K. are employees of Eli Lilly and Company and own stock in the company. K.T. and V.S. are employees of Eli Lilly and Company. G.Z. was employed by Eli Lilly at the time of the study, and is now employed by Pfizer Pharmaceuticals. D.M-S. has participated in advisory boards for Roche, Astra Zeneca, Eli Lilly, and Boehringer Ingelheim France. S.S. has received sponsorship from Eli Lilly. E.T. has received funding from Lilly Oncology to attend the World Cancer Conference and British Thoracic Oncology Group meeting, and from Roche Oncology to attend the ASCO annual meeting. She serves on the Clinical Advisory Board for Lilly Oncology, Roche Oncology and Boehringer-Ingelheim, and on the Speakers’ Bureau for Roche Oncology. A.V. has received funding from and served as a consultant for Eli Lilly, AstraZeneca, Roche and Sandoz, and has received funding from Chugai. B.P. and E.S. have no conflicts of interest to declare.
Acknowledgments
The authors would like to acknowledge Caroline Spencer (Rx Communications, Mold, UK) and Lee Baker (Rx Communications, Mold, UK) for medical writing assistance (funded by Eli Lilly and Company). The authors would also like to thank Astrid Kral (Eli Lilly and Company), Martin Marciniak (employed by Eli Lilly and Company at the time of the study), William John (Eli Lilly and Company), Gerhard Pohl (Eli Lilly and Company), and all the study investigators for their contribution to the study.
The authors did not receive financial compensation for writing this manuscript.