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First-Line Systemic Therapy in Metastatic Non-Small Cell Lung Cancer (mNSCLC) Patients Treated at National Comprehensive Cancer Network (NCCN) Institutions: An Analysis From the NCCN Oncology Outcomes Database Project

Citation: J Clin Oncol 28:7s, 2010 (suppl; abstr 7634)

Author(s): J. L. Vandergrift, R. Mamet, C. Zornosa, M. E. Reid, M. S. Rabin, D. S. Ettinger, G. P. Kalemkerian, G. A. Otterson, J. C. Niland, K. Pisters, NCCN Oncology Outcomes Database Non-Small Cell Lung Cancer Disease Specific Executive Committee; National Comprehensive Cancer Network, Fort Washington, PA; City of Hope, Duarte, CA; Roswell Park Cancer Institute, Buffalo, NY; Dana-Farber Cancer Institute, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The Ohio State University Medical Center and Arthur G. James Cancer Hospital and Solove Research Institute, Columbus, OH; University of Texas M. D. Anderson Cancer Center, Houston, TX

Abstract:

Background: The NCCN Clinical Practice Guidelines (GL) allow many systemic therapy options for patients (pts) with mNSCLC. The primary aims of this analysis were to identify first-line regimens for the treatment of mNSCLC pts and examine concordance with NCCN NSCLC GL.

Methods: The database was queried to identify pts with mNSCLC treated with first-line systemic therapy at 8 NCCN institutions presenting between September 2006 and March 2009. Pt characteristics, regimens utilized, and GL concordance were analyzed. Systemic therapy was categorized as cytotoxic doublet (CD), combination cytotoxic/targeted therapy (C/T), targeted therapy alone (T), or cytotoxic single agent (SA).

Results: A total of 983 eligible pts were identified, as follows: 51% male; median age 64 years; performance status (PS) was documented in 77% (82% PS 0 or 1; 11% PS 2; 7% PS 3 or 4). There were 729 pts (74%) treated with systemic therapy, 123 (17%) of which participated in a clinical trial. Most common reasons for not receiving therapy were death prior to treatment (37%), therapy was not recommended (35%), or unknown (20%). For PS 3 or 4 pts not enrolled in a clinical trial, 20/48 (42%) received systemic therapy. Systemic therapy administered: 437 CD (60%), 139 C/T (19%), 94 T (13%), and 46 SA (6%). A platin-agent was used in 96% of CDs, with carboplatin in 83%. Paclitaxel (45%), gemcitabine (22%), docetaxel (15%) and pemetrexed (9%) were the most common partner agents. Of 600 pts with adenocarcinoma, 50 (8%) were treated with pemetrexed. Bevacizumab with carboplatin and either paclitaxel or docetaxel were the most common C/Ts (85% of C/T, 16% of all treated). Erlotinib was the most common T (92% of T, 12% of all treated). Analyses of EGFR mutation testing and concordance to NCCN NSCLC GLs are underway.

Conclusions: The majority of pts with mNSCLC were treated with first-line systemic therapy and 17% participated in a clinical trial. Though not included in the NCCN GL prior to 2010, treatment of PS 3 or 4 pts and first-line therapy including erlotinib were observed. Few pts with adenocarcinoma received pemetrexed in the first-line setting.

 

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