Many patients with advanced non-small cell lung cancer (NSCLC) do not survive long enough to receive second-line therapy, according to a real-world study published in Cancer Treatment and Research Communications.

Of the nearly 500 patients evaluated in this study, 60% received first-line therapy only, and 42% of those patients did not proceed to second-line therapy because they had died.

Researchers conducted this study to evaluate treatment patterns and outcomes among patients with locally advanced or metastatic, stage IIIB-IV NSCLC. The team analyzed data from 497 patients without EGFR or ALK alterations who underwent first-line treatment between 2016 and 2019. 

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The median age of the cohort was 65 (range, 59-71) years, and 42.7% were women. Most (65.8%) were White, 23.7% were Black/African American, 7.0% were Asian, and 3.4% were classified as “other” race. Most patients (65.2%) had a history of smoking, 28.2% were current smokers, and 6.6% were never smokers.

The majority of patients (70.2%) had nonsquamous NSCLC, 27.0% had squamous cell histology, and 2.8% had mixed histology. Most patients had PD-L1 expression levels of 1%-49% (44.1%) or 50% or higher (25.6%), but 19.9% had PD-L1 expression levels less than 1%, and 10.5% of patients lacked data on PD-L1 expression. 

Treatment Over Time

The median follow-up from the start of first-line treatment was 13.7 months.

The most common first-line therapy was a combination of an immune checkpoint inhibitor (ICI) and platinum-doublet chemotherapy (40.6%). Patients also received platinum-doublet chemotherapy only (29.4%), ICI monotherapy (20.7%), and platinum-doublet chemotherapy plus bevacizumab (6.2%). 

The use of first-line platinum-doublet chemotherapy declined from 63% in 2016 to 10% in 2019. The use of first-line ICI plus platinum-doublet chemotherapy increased from 14% to 58% over the same period. The use of first-line ICI monotherapy increased from 11% to 26%. And the use of first-line platinum-doublet chemotherapy plus bevacizumab decreased from 10% to 3%.

Of the entire cohort, 60.2% of patients (n=299) received 1 line of therapy only, 33.2% (n=165) received 2 lines, and 6.6% (n=33) received 3 or more lines. 

The most common second-line regimens patients received were ICI monotherapy (42.4%), single-agent chemotherapy (18.2%), a VEGF inhibitor plus single-agent chemotherapy (15.7%), platinum-doublet chemotherapy alone (8.1%), and platinum-doublet chemotherapy plus bevacizumab (5.6%). 

The most common third- or later-line regimens were ICI monotherapy (15.2%), non-platinum doublet chemotherapy (12.1%), targeted therapy (6.0%), platinum-doublet chemotherapy (3.0%), single-agent chemotherapy plus ICI (3.0%), and other regimens (3.0%).

Treatment Outcomes

During first-line therapy, the objective response rate (ORR) was similar with ICI plus platinum-doublet chemotherapy (64.9%), ICI monotherapy (60.2%), and platinum-doublet chemotherapy plus bevacizumab (61.3%). The ORR with platinum chemotherapy alone was much lower, at 32.9%.

The median progression-free survival (PFS) and overall survival (OS) were longest among patients who received ICI monotherapy in the first line. 

The median PFS was 17.8 months with ICI monotherapy, 15.6 months with ICI plus platinum chemotherapy, 10.8 months with platinum chemotherapy and bevacizumab, and 5.3 months with platinum chemotherapy alone.

The median OS was not reached with ICI monotherapy, 26.5 months with ICI plus platinum chemotherapy, 18.6 months with platinum chemotherapy plus bevacizumab, and 13.7 months with platinum chemotherapy alone. 

Among patients who received only first-line therapy (n=299), 44.5% were still receiving that therapy at the end of the study period, 14.0% had stopped receiving first-line therapy but remained alive, and 41.5% had died. 

Disclosures: This study was supported by Novartis Pharmaceuticals Corporation. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Bazhenova L, Kish J, Cai B, Caro N, Feinberg B. Real-world observational study of current treatment patterns and outcomes in recurrent or locally advanced/metastatic non-small cell lung cancer. Cancer Treat Res Comm. Published online September 20, 2022. doi:10.1016/j.ctarc.2022.100637

This article originally appeared on Cancer Therapy Advisor