Chemotherapy treatment patterns in advanced (stage IV) non-small cell lung cancer

The authors aimed to evaluate the pattern of chemotherapy treatments and associated survival in advanced (stage IV) non-small cell lung cancer (NSCLC) patients.

In advanced NSCLC (stage IV), cancer spreads from lungs to different parts of the body. This is called metastasis. In this stage, chemotherapy is the standard treatment. However, many patients, mostly elderly, do not wish to receive chemotherapy. Severe adverse events without a larger survival benefit, lack of access to chemotherapy drugs and treatment wait times are some of the contributing factors. Chemotherapy drugs that seem to be effective in clinical trials may not have similar benefits in real-world NSCLC patients. This is due to the differences between the two patient populations; i.e. in clinical trials patients are chosen based on very specific criteria, but in the real world this does not happen. For this reason, doctors often do not prescribe chemotherapy for metastatic NSCLC.

The authors of this study aimed to report on the treatment patterns and outcomes in metastatic NSCLC. Published data from real world metastatic NSCLC patients diagnosed between 2005-2009 were analyzed.

Overall, 8,113 patients with an average age of 68 were identified. Of these, 39% had cancer in the glandular cells of lungs (adenocarcinoma), 14% in squamous cells of lungs and 43% had other types of NSCLC. Out of all patients, 24% had received chemotherapy. Among them, 16% received chemotherapy as the primary treatment (first-line of treatment) and 8% had received chemotherapy as both first and second line of treatments (offered when first line of treatment does not work adequately).

For those who received any chemotherapy, overall survival rates were similar for older (≥ 70 years, 10.4 months) and younger (10.1 months) patients. Regardless of age, those who received cisplatin (Platinol)–gemcitabine (Gemzar) as first-line chemotherapy survived 11.6 months longer on an average than those who received other chemotherapy as first line treatment.  Patients with non-squamous cell lung cancer, who were treated with second-line pemetrexed (Alimta), had longer average survival (19.8 months) than those who received docetaxel (Taxotere, 14.1 months).

The authors concluded that patients across all age groups who received first and second line of chemotherapy had similar survival rates compared to clinical trial results in stage IV NSCLC.

The majority of the patients (76%) did not receive chemotherapy. Further investigation is needed to identify other unknown factors leading to low treatment rates.