title: Real-world effectiveness of systemic agents approved for advanced non-small cell lung cancer: a SEER-Medicare analysis.
abstract: OBJECTIVE
  Disparity exists between patients with lung cancer enrolled in clinical trials and patients treated in the community setting. This study assessed the real-world effectiveness of cytotoxic agents that became available for the treatment of non-small cell lung cancer (NSCLC) in the last 2 decades.
  
  
  METHODS
  We employed the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database for patients diagnosed with stage IIIB/IV NSCLC between 1988 and 2005 to assess the effectiveness of newly approved agents. Effectiveness of specific agents was assessed at time periods immediately following the approval of the agent for NSCLC: baseline, 1988-1994; platinum, 1995-1999; docetaxel, 1999-2003; pemetrexed and bevacizumab, 2004-2005. Significant associations between specific drug treatment and survival improvement were determined using the Kaplan-Meier method, Cox proportional hazard model, and propensity score analyses. Significant differences were established by log-rank test.
  
  
  RESULTS
  This analysis employed data from 143,548 patients by sex (58% male, 42% female), cancer stage (35% stage IIIB, 65% stage IV), and age (12% 20-64 years, 22% 65-69 years, 45% 70-79 years, 22% 80 years and older). There was temporal improvement in survival for patients treated with newly approved chemotherapy (1-year survival rates: 32.41% in 1988-1994, 32.95% in 1995-1998, 37.40% in 1999-2003, and 39.55% in 2004-2005). Patients treated with a newly approved drug during the relevant treatment era had a significant reduction in the risk of death when compared with patients treated with chemotherapy other than the newly approved agent (hazard ratios [95% confidence interval] were 0.76 [0.71-0.81] for platinum, 0.73 [0.70-0.75] for docetaxel, 0.40 [0.37-0.44] for pemetrexed, and 0.33 [0.27-0.40] for bevacizumab; p < .001). Propensity score adjustment did not significantly alter these results.
  
  
  CONCLUSIONS
  Currently approved drugs for the treatment of advanced NSCLC are associated with improved survival in the U.S. Medicare patient population. Our findings support the effectiveness of these agents in the real-world oncology practice.
authors: Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia 30322, USA. towonik@emory.edu
authors: Taofeek K
authors: TK
authors: Owonikoko
authors: Camille
authors: C
authors: Ragin
authors: Zhengjia
authors: Z
authors: Chen
authors: Sungjin
authors: S
authors: Kim
authors: Madhusmita
authors: M
authors: Behera
authors: Johann C
authors: JC
authors: Brandes
authors: Nabil F
authors: NF
authors: Saba
authors: Rebecca
authors: R
authors: Pentz
authors: Suresh S
authors: SS
authors: Ramalingam
authors: Fadlo R
authors: FR
authors: Khuri
mesh_terms: D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D006278:Medicare; D015201:Meta-Analysis as Topic; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018426:SEER Program; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
keywords: Chemotherapy; Effectiveness; Lung cancer; Real world; SEER–Medicare; Survival
references: N Engl J Med. 1999 Dec 30;341(27):2061-7
references: 10615079
references: N Engl J Med. 2006 Dec 14;355(24):2542-50
references: 17167137
references: J Clin Oncol. 1994 Feb;12(2):360-7
references: 8113844
references: N Engl J Med. 2002 Jan 10;346(2):92-8
references: 11784875
references: Lung Cancer. 2007 Sep;57(3):348-58
references: 17485133
references: J Clin Oncol. 2000 May;18(10):2095-103
references: 10811675
references: JAMA. 2004 Jun 9;291(22):2720-6
references: 15187053
references: Arch Intern Med. 1994 Feb 28;154(4):433-7
references: 8117176
references: Med Care. 2002 Aug;40(8 Suppl):IV-55-61
references: 12187169
references: Lung Cancer. 2011 Oct;74(1):89-97
references: 21377753
references: J Clin Oncol. 1993 Oct;11(10):1866-72
references: 8410111
references: CA Cancer J Clin. 2011 Mar-Apr;61(2):91-112
references: 21303969
references: N Engl J Med. 2005 Jul 14;353(2):123-32
references: 16014882
references: J Clin Epidemiol. 1997 Aug;50(8):939-45
references: 9291879
references: Arch Pathol Lab Med. 2013 Jan;137(1):32-40
references: 22583114
references: Cancer. 1998 Nov 1;83(9):1930-7
references: 9806651
references: Med Care. 2002 Aug;40(8 Suppl):IV-3-18
references: 12187163
references: Lung Cancer. 2005 Jan;47(1):69-80
references: 15603856
references: JAMA. 2012 Apr 18;307(15):1593-601
references: 22511687
references: J Natl Cancer Inst. 2007 Jun 6;99(11):847-57
references: 17551145
references: Cancer Epidemiol Biomarkers Prev. 2010 Aug;19(8):1893-907
references: 20647400
references: J Clin Oncol. 2000 Apr;18(7):1451-7
references: 10735892
references: J Clin Oncol. 2006 Sep 20;24(27):4405-11
references: 16983108
references: J Clin Oncol. 2000 Jun;18(12):2354-62
references: 10856094
references: Arch Intern Med. 2008 Jul 28;168(14):1541-9
references: 18663166
references: CA Cancer J Clin. 2010 Sep-Oct;60(5):277-300
references: 20610543
references: J Clin Oncol. 2007 Dec 10;25(35):5570-7
references: 18065729
references: Chest. 1994 Sep;106(3):861-5
references: 7521815
references: Ann Oncol. 2013 Jan;24(1):20-30
references: 23180113
references: J Clin Oncol. 2010 May 1;28(13):2191-7
references: 20351329
references: Clin Lung Cancer. 2008 Mar;9(2):102-5
references: 18501096
references: J Clin Oncol. 2004 May 1;22(9):1589-97
references: 15117980
references: J Thorac Oncol. 2011 Jan;6(1):64-70
references: 21119545