title: Modern Treatments in Advanced Non-Small-Cell Lung Cancer: Temporal Trends and Effect on Survival. A French Population-Based Study.
abstract: Extrapolation of clinical trials results to the general population is always challenging. We analysed 1047 patients diagnosed with an advanced stage disease between 1998 and 2005 in a french administrative department and found a good spread of modern chemotherapy since 1998 and targeted therapy since 2002. Moreover, the outcomes in patients treated according to guidelines are very proximal from those obtained in clinical trials.
  
  
  BACKGROUND
  Management of metastatic non-small-cell lung cancer has considerably evolved during the past 2 decades. In this study we aimed to assess how treatments have spread at a population-based level and their effect on survival.
  
  
  METHODS
  Medical records of patients diagnosed from 1998 to 2005 in the French department of Bas-Rhin were checked to collect data on patient characteristics and treatments received. Multivariate analysis of survival was performed using pretherapeutic and therapeutic factors including targeted therapies received as third-line treatment.
  
  
  RESULTS
  We included 1047 patients with stage IIIB to IV non-small-cell lung cancer. The proportion of patients who underwent chemotherapy increased from 373/471 (79.2%) to 491/576 (85.2%) over the 1998 to 2001 and 2002 to 2005 periods, and there was an increased use of third-generation drugs associated with platin. Third-line treatment was gefitinib or erlotinib in 73/155 (47.1%) of the cases among patients diagnosed from 2002 to 2005. Compared with older agents, targeted therapy administered as third-line treatment was associated with a longer survival but there was no significant difference in survival with recent chemotherapy agents in multivariate analyses (hazard ratio, 0.773; 95% confidence interval, 0.445-1.343).
  
  
  CONCLUSIONS
  Results of our study showed a good spread of modern chemotherapy and targeted therapy use at a population-based level. However, even if the general outcomes were improved along the years, the results observed in real clinical practice were slightly different from those reported in clinical trials.
authors.affiliation: Laboratoire d'épidémiologie et de santé publique, EA3430, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Carpentier
authors.affiliation: Service de pneumologie, Nouvel Hôpital Civil, Strasbourg, France.
authors.forename: Lucia
authors.initials: L
authors.lastname: Selvaggi
authors.affiliation: Laboratoire d'épidémiologie et de santé publique, EA3430, Faculté de Médecine, Université de Strasbourg, Strasbourg, France; Service de santé publique, Nouvel Hôpital Civil, Strasbourg, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Jégu
authors.affiliation: Service de pneumologie, Nouvel Hôpital Civil, Strasbourg, France.
authors.forename: Ashok
authors.initials: A
authors.lastname: Purohit
authors.affiliation: Service de pneumologie, Nouvel Hôpital Civil, Strasbourg, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Prim
authors.affiliation: Laboratoire d'épidémiologie et de santé publique, EA3430, Faculté de Médecine, Université de Strasbourg, Strasbourg, France; Service de santé publique, Nouvel Hôpital Civil, Strasbourg, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Velten
authors.affiliation: Service de pneumologie, Nouvel Hôpital Civil, Strasbourg, France. Electronic address: elisabeth.quoix@chru-strasbourg.fr.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Quoix
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality; D000069347:Erlotinib Hydrochloride / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005602:France; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009367:Neoplasm Staging; D017671:Platinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D044382:Population Groups; D011799:Quinazolines / Q000008:administration & dosage / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D017671:Platinum Compounds; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride; D000077156:Gefitinib
keywords: Cancer registry; Chemotherapy; Generalizability; Outcomes; Targeted therapy