Real-World treatment outcomes for advanced NSCLC in Greece

Background: PD-(L)1 inhibitors were EMA approved as first and second line (1L, 2L) therapy in advanced NSCLC in 2017 and 2016, respectively. We investigated real-world (RW) treatment outcomes for patients (pts) with confirmed advanced NSCLC from the Sotiria Lung Cancer Registry, a hospital-based registry in Athens, Greece. Methods: This is a non-interventional, retrospective study of pts who started 1L treatment between Aug-2016-Aug-2019, with follow-up ending in Aug-2020. Baseline/treatment characteristics, responses (R), PFS and OS were analyzed. Results: A total of 705 pts (66.8% >65 years, 78.9% male, 70.0% ECOG PS 0/1) were included. At 1L, 415 (58.9%) pts received platinum-based chemo, 66 (9.4%) PD-(L)1 inhibitors (5.1% pembrolizumab), 63 (8.9%) anti-VEGF-based therapies, 40 (5.7%) tyrosine kinase inhibitors and 121 (17.2%) other regimens. PD-L1 testing rate was 34.0% (43.1% overall) and increased from 4.8% (2016) to 64% (2019). Of pts with PD-1/PD-L1-based therapies at 1L, 68.2% were tested for PD-L1, and 50.0% had PD-L1 expression ≥50.0%. In EGRF/ALK (-) or unknown pts at 1L (n=662), the median PFS and OS were 3.4 and 8.8 months, respectively, and R was 23.4% (for platinum- based chemo: 3.3, 10.3 and 24.7%; for PD-1/PD-L1: 12.0, 26.7, and 34.9%). In EGFR (+) or ALK (+) pts (n=43) the median PFS and OS were 5.3 and 17.7 months and R was 34.9%. At 2L, pts (n=280, 39.7%) received mostly PD-(L)1 inhibitors (50.4%). Conclusions: Most widely used 1L therapies were platinum-based chemo, and PD-(L)1 inhibitors at 2L, with PD-L1 testing being increased during the study period reaching nearly two-thirds of pts. RW outcomes suggest replacing chemo with anti-PD-(L)1-based regimens at 1L will be beneficial for EGFR/ALK (-) pts.