A multicenter survey of first-line treatment patterns and gene aberration test status of patients with unresectable Stage IIIB/IV nonsquamous non-small cell lung cancer in China (CTONG 1506)

Abstract

Background: In recent years, systemic chemotherapy and molecular targeted therapy have become standard first-line treatments for locally advanced or metastatic nonsquamous non-small cell lung cancer (NSCLC). The objective of this survey was to investigate first-line anticancer treatment patterns and gene aberration test status of patients with advanced nonsquamous NSCLC in China.

Methods: Patients included in this study had unresectable Stage IIIB/IV nonsquamous NSCLC and were admitted during August 2015 to March 2016 into one of 12 tertiary hospitals throughout China for first-line anticancer treatment. Patient data (demographics, NSCLC histologic type, Eastern Cooperative Oncology Group [ECOG] Performance Status [PS], gene aberration test and results [if performed], and first-line anticancer treatment regimen) were extracted from medical charts and entered into Medical Record Abstraction Forms (MERAFs), which were collated for analysis.

Results: Overall, 1041 MERAFs were collected and data from 932 MERAFs were included for analysis. Patients with unresectable Stage IIIB/IV nonsquamous NSCLC had a median age of 59 years, 56.4% were male, 58.2% were never smokers, 95.0% had adenocarcinoma, and 92.9% had an ECOG PS ≤1. A total of 665 (71.4%) patients had gene aberration tests; 46.5% (309/665) had epidermal growth factor receptor (EGFR) gene mutations, 11.5% (48/416) had anaplastic lymphoma kinase (ALK) gene fusions, and 0.8% (1/128) had a c-ros oncogene 1 gene fusion. The most common first-line treatment regimen for unresectable Stage IIIB/IV nonsquamous NSCLC was chemotherapy (72.5%, 676/932), followed by tyrosine kinase inhibitors (TKIs; 26.1%, 243/932), and TKIs plus chemotherapy (1.4%, 13/932). Most chemotherapy regimens were platinum-doublet regimens (93.5%, 631/676) and pemetrexed was the most common nonplatinum chemotherapy-backbone agent (70.2%, 443/631) in platinum-doublet regimens. Most EGFR mutation-positive patients (66.3%, 205/309) were treated with EGFR-TKIs.

Conclusions: Findings from our survey of 12 tertiary hospitals throughout China showed an increased rate of gene aberration testing, compared with those rates reported in previous surveys, for patients with advanced nonsquamous NSCLC. In addition, pemetrexed/platinum-doublet chemotherapy was the predominant first-line chemotherapy regimen for this population. Most patients were treated based on their gene aberration test status and results.

Keywords: Chemotherapy; China; Epidermal growth factor receptor; First-line anticancer treatment; Non-small cell lung cancer; Tyrosine kinase inhibitor.

Conflict of interest statement

Ethics approval and consent to participate

The protocol was approved by the Research Ethics Committee of the Guangdong General Hospital, Guangzhou, Guangdong, China and the study was supported by the Chinese Thoracic Oncology Group (CTONG study number 1506). Each site obtained its own institutional review board or ethics committee approval before the start of the study.

Consent for publication

Not applicable.

Competing interests

QS, LLY, and PHZ are employees of Lilly Suzhou Pharmaceutical Co., China. YLW has received honoraria from F. Hoffmann-La Roche, Eli Lilly, AstraZeneca, and Pfizer. All other authors declare that they have no competing interests.

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Figures

Fig. 1

Gene aberration rates of patients with unresectable Stage IIIB/IV nonsquamous non-small cell lung cancer. Patients tested for gene aberrations were classified as positive (activating mutations in exons 18-21), wild type, or unknown (findings inconclusive) for epidermal growth factor receptor (EGFR) gene mutations, and positive or negative for anaplastic lymphoma kinase (ALK) and c-ros oncogene 1 (ROS1) gene fusions

Fig. 2

Doublet chemotherapy regimens of patients with unresectable Stage IIIB/IV nonsquamous non-small cell lung cancer, n = 631. a Platinum agents. b Nonplatinum chemotherapy-backbone agents