Treatments and Outcomes After Platinum-Based Chemotherapy and Anti-PD-(L)1 in NSCLC.

Importance: Effective treatments for advanced or metastatic non-small cell lung cancer (NSCLC) are limited. Understanding clinical treatment patterns is critical for understanding unmet medical needs. Objective: To describe clinical treatment patterns and outcomes, including time to treatment discontinuation, progression-free survival, and overall survival, in patients who received platinum-based chemotherapy and anti-programmed cell death 1 protein or programmed cell death ligand 1 (PD-[L]1) regimens. Design, Setting, and Participants: This retrospective cohort study used data from 2018 to 2023 from a US nationwide, electronic health record-derived, deidentified database with median duration of follow-up of 7.8 (range, 0-65.0) months. Patients 18 years or older with advanced or metastatic NSCLC in second- and third-line treatment settings were included. Eligible patients had an Eastern Cooperative Oncology Group performance status of 0 or 1, received platinum-based chemotherapy and anti-PD-(L)1 therapy in 1 (combination) or 2 (sequential) lines, and initiated at least 1 subsequent treatment between January 1, 2018, and June 30, 2023. Exclusion criteria included disease progression within 8 weeks after anti-PD-(L)1 treatment initiation. Follow-up was until death or last available data through June 30, 2023. Exposures: Antineoplastic drugs following platinum-based chemotherapy and anti-PD-(L)1 treatment. Main Outcomes and Measures: Time to treatment discontinuation, progression-free survival, and overall survival were analyzed overall and by initial treatment. Exploratory subgroup analyses were stratified by patient characteristics and index treatment without adjustment for group differences. Results: In the 1793 patients (974 [54.3%] male) included in the analysis, mean (SD) age at index treatment was 67.4 (9.4) years and median time from advanced diagnosis to index treatment was 10.5 (range, 1.1-103.8) months. The most common index treatments were docetaxel plus ramucirumab (314 [17.5%]), docetaxel monotherapy (158 [8.8%]), and carboplatin plus paclitaxel (136 [7.6%]). Overall, median time from index treatment to treatment discontinuation was 3.71 (95% CI, 3.48-3.94) months; median progression-free survival, 5.29 (95% CI, 5.03-5.52) months; and median overall survival, 11.20 (95% CI, 10.48-11.93) months. In exploratory analyses, these outcomes were numerically shorter in patients who received chemotherapy monotherapy as index treatment vs the overall group; medians were numerically longer in patients who received index treatments of immuno-oncology monotherapy or chemotherapy plus immuno-oncology combination therapy. Conclusions and Relevance: In this retrospective cohort study of patients with advanced or metastatic NSCLC, results underscored a significant need for novel treatments, including immuno-oncology combinations.