title: Treatment Patterns for Advanced Non-Small-cell Lung Cancer After Platinum-containing Therapy in U.S. Community Oncology Clinical Practice.
abstract: Knowledge of the real-world treatment patterns for non-small-cell lung cancer (NSCLC) can identify quality-of-care gaps and guide resource allocation needs. Our objective was to describe the treatment patterns for advanced NSCLC after first-line chemotherapy in the era before the approval of immunotherapeutic agents.
  
  
  
  The present was a retrospective observational study of adult patients with advanced NSCLC (stage IIIB/IV or metastatic recurrence) who had completed a platinum-containing regimen, with an appropriate tyrosine kinase inhibitor if positive for epidermal growth factor receptor mutation or anaplastic lymphoma kinase translocation. Eligible patients initiated second-line chemotherapy from November 2012 through October 2014, recorded in an oncology record system for U.S. community clinics.
  
  
  
  Of 6867 patients with advanced NSCLC, 4188 (61%) initiated and 2707 (39%) completed platinum therapy, with a tyrosine kinase inhibitor, if appropriate. Subsequently 1889 of 2707 (70%) received second-line chemotherapy, including 1173 within the study period (844 [72%] nonsquamous, 275 [23%] squamous, and 54 [5%] not otherwise specified). The mean ± standard deviation patient age was 66 ± 10 years; 54% were male. Of the 94 different second-line regimens, docetaxel was the most common, prescribed to 14% of the patients overall and 14% and 16% of the nonsquamous and squamous cohorts, respectively. The median duration was 64 days (range, 1-455 days) and 48 days (range, 1-210 days) for the nonsquamous and squamous cohorts, respectively. The median duration by regimen category was 15 to 85 days (overall range, 1-953 days).
  
  
  
  These findings show the diversity, short treatment duration, and lack of efficacy of second-line chemotherapy regimens for NSCLC in the community oncology setting.
authors.affiliation: Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ. Electronic address: caroline.mckay@merck.com.
authors.forename: Caroline
authors.initials: C
authors.lastname: McKay
authors.affiliation: Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ.
authors.forename: Thomas
authors.initials: T
authors.lastname: Burke
authors.affiliation: Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ.
authors.forename: Xiting
authors.initials: X
authors.lastname: Cao
authors.affiliation: Flatiron Health, Inc., New York, NY.
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
authors.affiliation: Medical Oncology, The James, The Ohio State University Comprehensive Cancer Center, Columbus, OH.
authors.forename: David P
authors.initials: DP
authors.lastname: Carbone
mesh_terms: D000368:Aged; D000077548:Anaplastic Lymphoma Kinase; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D066246:ErbB Receptors / Q000235:genetics; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D017671:Platinum Compounds / Q000008:administration & dosage; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics; D012189:Retrospective Studies; D013997:Time Factors; D014178:Translocation, Genetic; D016896:Treatment Outcome; D014481:United States
chemical_list: D017671:Platinum Compounds; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D066246:ErbB Receptors; D020794:Receptor Protein-Tyrosine Kinases
keywords: Biomarker testing; Flatiron Health; Line of therapy; NSCLC; Real-world treatment patterns