Real-world practice patterns for patients with advanced non-small cell lung cancer: multicenter retrospective cohort study in Japan

Abstract

Background

Recommended therapies for advanced/metastatic non-small cell lung cancer (NSCLC) have changed with the advent of targeted therapies. The objectives of this retrospective chart review study were to describe treatment patterns, biomarker testing practices, and health care resource use for advanced NSCLC at 5 sites in Japan.

Patients and methods

We studied anonymized medical record data of patients aged ≥18 years who initiated systemic therapy for newly diagnosed stage IIIB or IV NSCLC from January 2011 through June 2013. Data were analyzed descriptively by histology and mutation status. Overall survival was estimated using the Kaplan–Meier method.

Results

We studied 175 patients, including 43 (25%), 129 (74%), and 3 (2%) with squamous, nonsquamous, and unknown NSCLC histology, respectively; 83% had stage IV NSCLC. Overall, 123 patients (70%) were male; the median age was 70 years (range, 47–86); and 33 (19%) were never-smokers. In the nonsquamous cohort, 105 (81%) and 25 (19%) of patients were tested for epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement, respectively; 44 (42%) had EGFR-positive NSCLC and 2 (8%) had ALK-positive NSCLC, including 26/46 (57%) women and 21/46 (46%) never-smokers. In the squamous cohort, 17 (40%) and 4 (9%), respectively, were tested; 1 EGFR-positive tumor was detected. After first-line therapy, 105 (60%) patients received second-line, and 54/105 (51%; or 31% overall) received third-line therapy. EGFR tyrosine kinase inhibitors were most commonly prescribed for EGFR-positive NSCLC across all lines. In the nonsquamous EGFR/ALK-negative/unknown cohort, most received first-line platinum combinations, particularly younger patients (78% ≥75 years vs 93% <75 years old). The average hospitalization was 21 days/admission. The median (95% CI) overall survival from start of first-line therapy was 9.9 months (7.6–11.7) for all patients and 17.9 months (9.9–24.4) for patients with EGFR/ALK-positive status.

Conclusion

Biomarker testing is common for nonsquamous NSCLC at the 5 Japanese study sites. Treatment is personalized by mutation status and age, per guideline recommendations.

Keywords:

• predictive biomarker
• health care resource use
• Japan
• non-small cell lung cancer
• systemic therapy
• treatment patterns

Supplementary materials

Approving ethics committees

The study protocol conformed to the provisions of the October 2013) and was approved by the head of each study Declaration of Helsinki (as revised in Fortaleza, Brazil, site after review by the institutional ethics committee (EC).

Table

Table S1 Treatment patterns for patients with advanced NSCLC, squamous histologya

Table S2 Treatment patterns for patients with advanced NSCLC, nonsquamous histology and EGFR/ALK-negative or unknown status, or not testeda

Table S3 Treatment patterns for patients with advanced NSCLC, nonsquamous histology and EGFR/ALK-positive statusa

Table S4 Treatment patterns for all patients with advanced NSCLCa

Acknowledgments

This study was sponsored by Merck & Co., Inc., Kenilworth, NJ, USA. We thank QuintilesIMS (Cambridge, MA, USA) for data acquisition and statistical support, Yu Feng and Mary Anne Rutkowski (Merck & Co., Inc., Kenilworth, NJ, USA) for statistical programming support, and Reshma Shinde (Merck & Co., Inc., Kenilworth, NJ, USA) for editorial and administrative support. Medical writing and editorial assistance was provided by Elizabeth V. Hillyer, DVM. This assistance was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Disclosure

Hiroshi Isobe has received payment for speaking engagements from AstraZeneca, Bristol-Myers Squibb, Kyowa Hakko Kirin, Chugai, Boehringer Ingelheim, Ono Pharmaceutical Co. Ltd., and Eli Lilly, Japan KK. Koichi Minato has received research funding for his institution from Ono Pharmaceutical Co., Ltd., and Chugai Pharmaceutical Co., Ltd. Kazuko Taniguchi is an employee of MSD KK, and Ashwini Arunachalam, Smita Kothari, and Xiting Cao are employees of Merck & Co., Inc., Kenilworth, NJ, USA, the sponsor of this study. Terufumi Kato has received honoraria from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai, Kyowa Hakko Kirin, Lilly, Ono, Pfizer, Roche, and Taiho, and has received research funding from Abbvie, Astellas, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Kyowa Hakko Kirin, Lilly, Merck Sharp & Dohme, Ono, Parexel, Pfizer, Quintiles, Taiho, Takeda, Yakult Honsha. The authors report no other conflicts of interest in this work.