BACKGROUND: Advanced squamous non-small cell lung cancer (NSCLC) represents approximately 22% of all lung cancer cases in the US. Although prognosis is generally poor, treatment selection plays an important role in prolonging survival for these patients. In this study, we described treatment patterns observed in real-world clinical settings for US Medicare enrollees diagnosed with advanced squamous NSCLC.
METHODS: A retrospective analysis was conducted using the SEER-Medicare linked database for patients with advanced squamous NSCLC aged ≥65 years and diagnosed during 2001-2009. Post-diagnosis prevalence of broad categories of cancer-directed treatment approaches (surgery, radiation, chemotherapy, biologic therapy) was analyzed. Among patients initiating a systemic therapy regimen, detailed characteristics of the most frequently observed first-, second-, and third-line regimens were assessed.
RESULTS: A total of 17,133 patients were identified for study inclusion (median age 75, 62% male). Of the total sample, 56% received radiation, 45% received chemotherapy, 19% received surgery, and 1% received biologic therapy. Overall, approximately 72% of the total sample received ≥1 cancer-directed treatment. Among patients initiating a first-line systemic treatment (n=7,029), the most common regimen was, by far, carboplatin plus paclitaxel combination therapy (46%); the next most common first-line regimen (10% of patients) was carboplatin plus gemcitabine. Of all first-line systemic regimen initiators, 48% subsequently initiated a second-line regimen; 24% went on to initiate a third-line regimen. Gemcitabine monotherapy was the most frequently used regimen in second- (16%) and third-line settings (16%). Docetaxel monotherapy was second most common second-line regimen (13%).
CONCLUSIONS: Consistent with current National Cancer Center Network (NCCN) treatment guidelines, platinum-based doublet chemotherapy was the most common first-line treatment among chemotherapy-treated patients in the real-world settings captured in our study. Second-line treatment selections were more varied and not necessarily consistent with current NCCN recommendations.
