# Real-World Treatment Patterns and Survival in Patients with Advanced Non-Small Cell Lung Cancer: An Italian Retrospective Cohort Study

## TL;DR

This study examines treatment trends and survival outcomes for advanced lung cancer patients in Italy from 2014 to 2022, showing improved survival with newer therapies like immunotherapy and targeted treatments.

## Contribution

The study provides real-world evidence of treatment effectiveness and survival trends in advanced NSCLC in Italy, highlighting the impact of immunotherapy and targeted therapies.

## Key findings

- The use of immunotherapy (anti-PD-(L)1 ICIs) as first-line treatment increased from 0% to 58% between 2014 and 2021.
- Median overall survival improved from 6.0–7.4 months (2014–2017) to 8.4–15.9 months (2018–2021).
- Patients receiving targeted therapy or with high PD-L1 expression had longer survival.

## Abstract

Globally, lung cancer is the leading cause of cancer-related mortality, with most patients diagnosed with advanced (stage III or IV) non-small-cell lung cancer (NSCLC). Available treatments for advanced NSCLC have significantly expanded over the past decade, creating a need to evaluate real-world treatment patterns and effectiveness before and after the introduction of these newer therapies. This study describes patient characteristics, treatment patterns and survival among patients with advanced NSCLC (including locally advanced or metastatic disease) at the IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) in Italy between 2014 and 2022. In alignment with other real-world studies, results from this study suggest that, despite a generally poor prognosis for patients with advanced NSCLC, those with actionable genomic alterations benefit from treatment with precision targeted therapies, and the approval of immunotherapies has further evolved the treatment paradigm for advanced NSCLC.

Background: Treatment for advanced non-small-cell lung cancer (NSCLC) has evolved substantially over the past decade, necessitating evaluation of real-world treatment patterns and effectiveness before and after the introduction of newer therapies. Methods: This retrospective cohort study included adult patients initiating a non-curative first-line therapy for advanced NSCLC between 2014 and 2021 at the IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST), with follow-up through 2022. Overall survival (OS) and real-world progression-free survival from the start date of the first line of therapy for advanced NSCLC were estimated using Kaplan–Meier methods. Results: Overall, 910 patients were included; at diagnosis, 83% had a de novo diagnosis and 17% had recurrent disease. During the study, 41% of patients received platinum-based chemotherapy alone; 22% received non-platinum-based chemotherapy alone; 21% received anti-programmed death (PD)-(ligand [L])1 immune checkpoint inhibitors (ICIs), alone or with chemotherapy; and 16% received targeted therapy (single-agent tyrosine kinase inhibitors) as first-line therapy for advanced disease. From 2014 to 2021, the proportion of patients receiving first-line anti-PD-(L)1 ICIs increased from 0% to 58% and the proportion of those receiving first-line platinum-based chemotherapy decreased from 65% to 6%. Median (95% CI) OS was 8.2 (7.5–9.2) months; the minimum-to-maximum range of median OS was 6.0–7.4 months from 2014 to 2017 and 8.4–15.9 months from 2018 to 2021. Median OS was numerically longer in patients with recurrent disease versus a de novo diagnosis, first-line targeted versus other therapy, high versus low PD-L1 expression, and non-squamous/other versus squamous histology. Conclusions: This study provides real-world data further supporting (i) the benefits of precision targeted therapy for patients with advanced NSCLC and actionable genomic alterations and (ii) the positive impact of immunotherapy approvals on the treatment paradigm for advanced NSCLC.