Key Points
• Conclusion/Relevance: “Our findings expand on the SEER data and provide additional evidence suggesting improvements in survival of patients with advanced and metastatic NSCLC over the past decade could be explained by the change in treatment patterns over this period.”
• The researchers leveraged patient-level data from a large US electronic health record (EHR) database to analyze enhancements in the survival of patients with advanced or metastatic NSCLC. They also explored these relationships with changes in treatment patterns.
• “Significant improvements in survival among patients with non-oncogene positive tumors were observed from 2015 onwards, a timing that aligns with the earliest approvals of immunotherapies for this population,” stated the authors.
• “The absence of an improvement in survival among patients who had EGFR+ tumors is notable given we observed a large increase in the use of second and third generation EGFR inhibitors over our study period,” the authors wrote. “Notably, the overall proportion of patients receiving any EGFR inhibitor (i.e., 1st/2nd/3rd gen) remained relatively stable over the study period suggesting that the incremental benefit of 3rd generation over 1st and 2nd generation products may not have translated into a large enough population level benefit over time for us to have the power to identify it in this study.”
• Although the researchers were able to use patient-level data to investigate the relationship between treatment, calendar time, and outcomes, this data was observational. Consequently, other confounding variables, which were not accounted for in sensitivity analysis, could have played a role. Another limitation was that small numbers of patients treated with some products resulted in the categorization of treatments into classes, with it sometimes being necessary to combine two classes of drug.

Discussion question: With respect to targeted and immunotherapy in advanced/metastatic NSCLC, what trends have you noticed?