Epidemiological trends of non-small cell lung cancer and systemic treatment rates as part of initial therapeutic strategy from 2016 to 2020 in Greece: results of the epidemiological part of INFINITY study.

backgroundIn view of the shifting standard of care for non-small cell lung cancer (NSCLC), we aimed to capture the evolution of the epidemiological and systemic treatment (ST) landscape in Greece.

methodsThis non-interventional, single-country, multicenter, retrospective study, collected high-level aggregate data for adult patients who were newly diagnosed with histologically/cytologically confirmed Stage I-IV NSCLC between 01-Jan-2016 and 31-Dec-2020 (index period) at leading oncology clinics across the country.

resultsOverall, 10,644 patients were newly diagnosed with NSCLC during the entire 5-year index period at the 18 participating sites (63.8% of the patients inside Attica; 51.0% at public academic institutions). An increasing trend in NSCLC diagnoses was observed throughout the index period, with the largest rise seen from n = 1765 in 2016 to n = 2013 in 2017 which was driven by an abrupt increase in Stage IV diagnoses, and the lowest from n = 2332 in 2019 to n = 2373 in 2020. Over the index period, 5.9%, 10.3%, 23.4% and 60.4% of all cases were Stage I, II, III, and IV, respectively. Of the Stage I and II patients, 41.3% and 73.3% were treated with ST, respectively, which mostly comprised of chemotherapy, with negligible variations through the years. Most of the Stage III and IV patients received ST (85.9% and 88.4%, respectively) with respective overall chemotherapy rates of 82.6% and 63.8% which remained relatively constant over the examined years, and immunotherapy utilisation rates of 29.6% and 31.3% which exhibited gradual and substantial increases (reaching 43.5% and 55.0% in 2020). Among Stage IV patients, 6.6% and 4.8% were treated with targeted and investigational therapies, respectively, accounting for the majority of NSCLC patients treated with such therapies (88.4% and 86.6%). Institutional variations were noticed in temporal trends of NSCLC diagnoses, stage distribution, and ST rates.

conclusionThe number of new NSCLC cases continues to rise with more than half still presenting with metastatic disease. Albeit certain medical practice variations, the observed remarkable increases in immunotherapy use are aligned with immune checkpoint inhibitor approvals and their incorporation into European and national clinical practice guidelines.