Real-world treatment patterns and attrition for non-driver mutation metastatic non-small cell lung cancer in the US.

AIMS: Programmed cell death protein-1/ligand-1 (PD-1/PD-L1) inhibitors (PD-[L]1) are standard of care for patients with metastatic non-small cell lung cancer (mNSCLC). This study examined real-world treatment patterns and attrition by lines of therapy (LOTs) among patients with non-driver mutation mNSCLC. PATIENTS & METHODS: A retrospective study of adult patients with mNSCLC (2015‒2022) who received ≥1 systemic treatment in COTA's United States multicenter NSCLC database was conducted. Treatment patterns, duration, and outcomes were summarized descriptively. PD-(L)1 utilization was stratified by PD-L1 expression levels (<1%, 1%‒49%, ≥50%). RESULTS: Among the 2,107 eligible patients, PD-(L)1-based therapy was the most common frontline therapy (55.8%); of these, 60.5% received PD-(L)1/platinum combination therapy. Among PD-(L)1 users, frontline PD-(L)1 monotherapy was most frequently utilized in patients with PD-L1 expression ≥50% (66.2%). Utilization of frontline platinum chemotherapy without PD-(L)1 decreased from 76.8% (2015) to <15% (2019-2022). Mortality across LOTs 1-4 was 37.4%-42.2% and attrition was approximately 60% for each LOT. The overall median duration of LOT1 was 5.4 months. A decreasing trend in the treatment and LOT duration of subsequent LOTs was observed. CONCLUSIONS: Despite incorporating PD-(L)1-based therapies for frontline mNSCLC, mortality and attrition during LOT1 remained high and therapy duration was short, reflecting challenges in managing mNSCLC.