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Introduction <p>Immuno-oncology (IO) agents and pemetrexed are approved for the first-line (1L) maintenance treatment (1LMT) of advanced/metastatic non-small cell lung cancer (a/mNSCLC). This international retrospective chart review assessed real-world treatment patterns and outcomes in patients with a/mNSCLC lacking targetable mutations.</p> Methods <p>Oncologists from seven countries (Canada, France, Germany, Italy, Spain, UK, USA) provided deidentified, medical chart-derived data on randomly selected adults with a/mNSCLC who remained stable or responded to 1L chemotherapy + IO. Treatment patterns, overall survival (OS), progression-free survival (PFS), and healthcare resource utilization (HCRU) were compared by maintenance treatment use following propensity score weighting. The effects of adding pemetrexed to IO-containing 1LMT was investigated in patients with non-squamous/mixed histology.</p> Results <p>Of 942 patients analyzed, 680 initiated 1LMT. After weighting, 1LMT was associated with longer median PFS (17.7 vs 7.1&#xa0;months; HR [95%&#xa0;CI] 0.63 [0.41–0.85]), similar OS (31.7 vs 31.0&#xa0;months; 0.82 [0.47–1.17]), and fewer mean monthly hospitalizations (0.03 vs 0.1; <i>p</i> &lt; 0.01) versus no 1LMT. Among 469 patients with non-squamous/mixed histology who initiated an IO-containing 1LMT, 283 received IO only while 186 received IO + pemetrexed. Median time to treatment discontinuation (20.0 vs 11.0&#xa0;months; <i>p</i> &lt; 0.001), PFS (21.1 vs 11.1&#xa0;months; HR [95%&#xa0;CI] 0.56 [0.37–0.76]), and OS (35.3 vs 27.3&#xa0;months; 0.70 [0.41–0.98]) were longer for patients receiving IO only versus IO + pemetrexed. Fewer patients administered IO only experienced fatigue (28.3% vs 39.8% [IO + pemetrexed];<i> p</i> &lt; 0.05) and anemia (16.6% vs 31.2%; <i>p</i> &lt; 0.001).</p> Conclusion <p>1LMT was associated with significantly longer PFS and similar OS, without substantially increasing HCRU, among the current study population with a/mNSCLC. Adding pemetrexed to 1LM IO did not confer significant clinical benefit in patients with non-squamous/mixed histology and these patients incurred more adverse events. Additional 1LMT options are needed to further improve clinical outcomes.</p>

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Real-World Maintenance Treatment Patterns Among Patients with Advanced Non-Small Cell Lung Cancer

  • 期刊论文

  • 发表日期：

    2025年4月15日

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  • Manasee V. Shah,
  • Caitlyn T. Solem,
  • Kelly F. Bell,
  • Amine Aziez,
  • Xuezheng Sun,
  • Mandy Du,
  • Ella X. Du,
  • Hongbo Yang,
  • Hongjue Wang,
  • Qi Hua,
  • Umit Tapan

摘要

Introduction

Immuno-oncology (IO) agents and pemetrexed are approved for the first-line (1L) maintenance treatment (1LMT) of advanced/metastatic non-small cell lung cancer (a/mNSCLC). This international retrospective chart review assessed real-world treatment patterns and outcomes in patients with a/mNSCLC lacking targetable mutations.

Methods

Oncologists from seven countries (Canada, France, Germany, Italy, Spain, UK, USA) provided deidentified, medical chart-derived data on randomly selected adults with a/mNSCLC who remained stable or responded to 1L chemotherapy + IO. Treatment patterns, overall survival (OS), progression-free survival (PFS), and healthcare resource utilization (HCRU) were compared by maintenance treatment use following propensity score weighting. The effects of adding pemetrexed to IO-containing 1LMT was investigated in patients with non-squamous/mixed histology.

Results

Of 942 patients analyzed, 680 initiated 1LMT. After weighting, 1LMT was associated with longer median PFS (17.7 vs 7.1 months; HR [95% CI] 0.63 [0.41–0.85]), similar OS (31.7 vs 31.0 months; 0.82 [0.47–1.17]), and fewer mean monthly hospitalizations (0.03 vs 0.1; p < 0.01) versus no 1LMT. Among 469 patients with non-squamous/mixed histology who initiated an IO-containing 1LMT, 283 received IO only while 186 received IO + pemetrexed. Median time to treatment discontinuation (20.0 vs 11.0 months; p < 0.001), PFS (21.1 vs 11.1 months; HR [95% CI] 0.56 [0.37–0.76]), and OS (35.3 vs 27.3 months; 0.70 [0.41–0.98]) were longer for patients receiving IO only versus IO + pemetrexed. Fewer patients administered IO only experienced fatigue (28.3% vs 39.8% [IO + pemetrexed]; p < 0.05) and anemia (16.6% vs 31.2%; p < 0.001).

Conclusion

1LMT was associated with significantly longer PFS and similar OS, without substantially increasing HCRU, among the current study population with a/mNSCLC. Adding pemetrexed to 1LM IO did not confer significant clinical benefit in patients with non-squamous/mixed histology and these patients incurred more adverse events. Additional 1LMT options are needed to further improve clinical outcomes.