Despite Superior Outcomes With IO and Targeted Therapy, Chemo Remains Top Treatment in aNSCLC

Researchers say increase in immunotherapy was significant over the study period between 2016 and 2018.

While immunotherapy is rapidly being adopted, it’s still not typically used in the first-line setting for advanced non-small cell lung cancer (aNSCLC), says a new retrospective study in the United Kingdom, which found that chemotherapy was used most commonly.

Nevertheless, the researchers say, the increase in immunotherapy was significant over the study period between 2016 and 2018. Use of the treatment as monotherapy increased from 0% to over 25%. Use of targeted therapies also increased, albeit less substantially (11.8% to 15.9%).

Throughout the study period, chemotherapy remained the most commonly used treatment (88.5% in 2016, 58.2% in 2018) among the approximately 1000 patients.

“Despite the increase in [first-line] treatment options for aNSCLC in recent years, patient outcomes remained poor in our study population, with a median [overall survival] of only 9.5 months, median [time to death] of 2.1 months, and [real-world tumor response] in 29.0%,” wrote the researchers, noting that immunotherapy did improve survival, with a median OS of 14 months, a median TTS of 5.3 months. Patients receiving this type of treatment also had higher rwTR, with 31%.

The most commonly used immunotherapy was pembrolizumab and most commonly used targeted therapy was afatinib.

According to the researchers, information on PD-L1 status was not available, so use of first-line immunotherapy in the context of PD-L1-positivity was not possible.

Although they were used least frequently, targeted therapies were associated with the longest OS, with a median OS of 20.2 months.

“Only around 30% of patients in our study population received [second-line] therapy, which emphasizes the importance of selecting the most effective [first-line] treatment,” explained the researchers, adding that the most common second-line treatment was immunotherapy. “This observation may reflect the poor condition of patients with disease progression after [first-line] treatment and/or perceptions of the risk-benefit ratio for [second-line] treatment options in the population.”

Among the patients who received immunotherapy as first-line treatment, chemotherapy was most often used as their second-line treatment and among patient who received first-line targeted therapy, targeted therapy often remained as their second-line treatment.


Lester J, Escriu C, Khan S, et al. Retrospective analysis of real-world treatment patterns and clinical outcomes in patients with advanced non-small cell lung cancer starting first-line systemic therapy in the United Kingdom. BMC Cancer. Published online May 7, 2021. doi: 10.1186/s12885-021-08096-w

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