title: Real-world chemotherapy treatment patterns in metastatic non-small cell lung cancer: Are patients undertreated?
abstract: BACKGROUND
  New therapies for metastatic non-small cell lung cancer (NSCLC) have improved survival in clinical trials. However, only a minority of patients receive systemic therapy. This article reports treatment patterns and outcomes for a population of Canadian patients with metastatic NSCLC (Ontario).
  
  
  METHODS
  Patients diagnosed with stage IV NSCLC from 2005 to 2009 were identified through multiple linked provincial databases. Patient demographics, systemic treatment, and survival were examined over time.
  
  
  RESULTS
  Metastatic NSCLC patients (n = 8113) were identified. The median age was 68 years; 39% had adenocarcinoma, 14% had squamous carcinoma, and a higher than expected proportion (43%) had NSCLC not otherwise specified. Only 24% the patients received first-line chemotherapy; only 31% of these received second-line chemotherapy. More patients received systemic therapy over time (from 19% in 2005 to 26% in 2009, P < .0001). Patients who were less than 70 years old or had adenocarcinoma were more likely to receive systemic therapy (P < .0001 for both). The median survival, regardless of age, for those selected to receive first-line cisplatin-gemcitabine chemotherapy was longer than that for those receiving other nonpemetrexed platinum doublets at 11.6 months (P = .0002). Patients with nonsquamous histology who were treated with second-line pemetrexed had longer median survival than those treated with docetaxel (19.8 vs 14.1 months, P < .0001).
  
  
  CONCLUSIONS
  Most patients with metastatic NSCLC in the general population still do not receive systemic therapy. Those selected for first- and second-line systemic treatment, including older patients, have survival outcomes comparable to clinical trial results. Older patients and patients with squamous histology are less likely to receive chemotherapy. The low levels of treatment utilization in this study warrant further investigation.
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.|Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.|Faculty of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Adrian G
authors.initials: AG
authors.lastname: Sacher
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.|Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, Toronto, Canada.
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Le
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.|Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, Toronto, Canada.
authors.forename: Anthea
authors.initials: A
authors.lastname: Lau
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.|Faculty of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Natasha B
authors.initials: NB
authors.lastname: Leighl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009864:Ontario / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: chemotherapy; health services; metastatic; non-small cell lung cancer (NSCLC); systemic therapy; treatment patterns