Trends in the prescription of systemic anticancer therapy and mortality among patients with advanced non-small cell lung cancer: a real-world retrospective observational cohort study from the I-O optimise initiative.

Objectives: To assess how a decade of developments in systematic anticancer therapy (SACT) for advanced non-small cell lung cancer (NSCLC) affected overall survival (OS) in a large UK University Hospital.
Design: Real-world retrospective observational cohort study using existing data recorded in electronic medical records.
Setting: A large National Health Service (NHS) university teaching hospital serving 800 000 people living in a diverse metropolitan area of the UK.
Participants: 2119 adults diagnosed with advanced NSCLC (tumour, node, metastasis stage IIIB or IV) between 2007 and 2017 at Leeds Teaching Hospitals NHS Trust.
Main Outcomes and Measures: OS following diagnosis and the analysis of factors associated with receiving SACT.
Results: Median OS for all participants was 2.9 months, increasing for the SACT-treated subcohort from 8.4 months (2007-2012) to 9.1 months (2013-2017) (p=0.02); 1-year OS increased from 33% to 39% over the same period for the SACT-treated group. Median OS for the untreated subcohort was 1.6 months in both time periods. Overall, 30.6% (648/2119) patients received SACT; treatment rates increased from 28.6% (338/1181) in 2007-2012 to 33.0% (310/938) in 2013-2017 (p=0.03). Age and performance status were independent predictors for SACT treatment; advanced age and higher performance status were associated with lower SACT treatment rates.
Conclusion: Although developments in SACT during 2007-2017 correspond to some changes in survival for treated patients with advanced NSCLC, treatment rates remain low and the prognosis for all patients remains poor.
Competing Interests: Competing interests: REAL-Oncology is a collaboration between Leeds Teaching Hospital NHS Trust and IQVIA. Commercial clients of IQVIA include Bristol Myers Squibb (BMS), which funded the project this work is based on. REAL-Oncology retains all operational, scientific and communications controls. GH is an employee of the University of Leeds and holds an honorary contract with Leeds Teaching Hospital NHS Trust. GH leads the Leeds Teaching Hospitals NHS Trust real-world evidence team collaboration with IQVIA and, as part of this collaboration, IQVIA fund the staff who support this work. GH also reports partial grant funding for a collaboration outside this study from IQVIA. MS was an employee at Leeds Teaching Hospital NHS Trust at the time of the study and he holds an honorary contract with Leeds Teaching Hospital NHS Trust. MS, MT and MR are employees of IQVIA. WS and SC are subcontracted to IQVIA and hold honorary contracts with Leeds Teaching Hospital NHS Trust. MS receives consultancy fees from BMS. CC, MMD, JRP and JCO’D are employees of BMS. CC and JRP report stock ownership in BMS. LL was contracted (paid) as consultant by BMS to support the I-O Optimise initiative and is an employee of Epi-Fit. There are no further conflicts of interest.
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