Uptake of novel systemic therapy: Real world patterns among adults with advanced non-small cell lung cancer.
Uptake of novel systemic therapy: Real world patterns among adults with advanced non-small cell lung cancer.
复制标题
DOI：
10.1016/j.ctarc.2023.100730
复制
发表时间：
2023
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
晚期非小细胞肺癌（NSCLC）的全身治疗正在从基于铂类的化疗转向与临床试验中生存率提高相关的免疫治疗和靶向治疗。随着新疗法的批准使用，检查社区实践中用于治疗患者的变化可以产生关于其益处大小的额外证据。我们确定了2012年3月1日至2020年12月31日期间诊断为原发IV期NSCLC的1，442例患者。患者的特征和治疗模式进行了整体描述，并通过类型的一线和二线系统治疗接受。患病率估计患者和肿瘤特征与接受一线治疗的相关性。在确诊后的180天内，949名（66%）患者接受了一线全身治疗，从2012年的53%增加到2020年的71%（p = 0.0004）。接受一线免疫治疗+/−化疗（IMO）的患者比例从14%增加到66%（p<0.0001）。总体而言，380例（26%）患者同时接受一线和二线治疗，各年变化范围为16%-36%（p = 0.18）。接受二线IMO的患者比例从13%增加到37%（p<0.0001）。年龄较大和当前吸烟状态与一线治疗的接受呈负相关。较高的BMI、接受放疗和诊断年份与一线治疗呈正相关。没有发现与种族、民族或社会经济地位有关。接受一线和二线治疗的晚期NSCLC患者比例随着时间的推移而增加，尤其是IMO治疗。需要进行更多的研究，以更好地了解这些疗法对患者结局的影响，包括短期、长期和经济毒性。非小细胞肺癌（NSCLC）的全身治疗正在从铂类药物治疗转向免疫治疗和靶向治疗。使用从4个医疗保健系统中确定的新发IV期NSCLC患者，我们研究了全身治疗的趋势。我们看到接受任何全身治疗的患者比例增加，接受免疫治疗的患者比例急剧增加。
Systemic treatment for advanced non-small cell lung cancer (NSCLC) is shifting from platinum-based chemotherapy to immunotherapy and targeted therapies associated with improved survival in clinical trials. As new therapies are approved for use, examining variations in use for treating patients in community practice can generate additional evidence as to the magnitude of their benefit. We identified 1,442 patients diagnosed with de novo stage IV NSCLC between 3/1/2012 and 12/31/2020. Patient characteristics and treatment patterns are described overall and by type of first- and second-line systemic therapy received. Prevalence ratios estimate the association of patient and tumor characteristics with receipt of first-line therapy. Within 180 days of diagnosis, 949 (66%) patients received first-line systemic therapy, increasing from 53% in 2012 to 71% in 2020 (p = 0.0004). The proportion of patients receiving first-line immunotherapy+/−chemotherapy (IMO) increased from 14%–66% (p<0.0001). Overall, 380 (26%) patients received both first- and second-line treatment, varying by year between 16%–36% (p = 0.18). The proportion of patients receiving second-line IMO increased from 13%–37% (p<0.0001). Older age and current smoking status were inversely associated with receipt of first-line therapy. Higher BMI, receipt of radiation, and diagnosis year were positively associated with receipt of first-line therapy. No association was found for race, ethnicity, or socioeconomic status. The proportion of advanced NSCLC patients receiving first- and second-line treatment increased over time, particularly for IMO treatments. Additional research is needed to better understand the impact of these therapies on patient outcomes, including short-term, long-term, and financial toxicities. Systemic treatment for non-small cell lung cancer (NSCLC) is shifting from platinum-based therapies to immunotherapy and targeted therapies. Using de novo stage IV NSCLC patients identified from 4 healthcare systems, we examine trends in systemic therapy. We saw an increase in the portion of patients receiving any systemic therapy and a sharp increase in the proportion of patients receiving immunotherapy.