(P-141) Using Administrative Data and the Regional Pathology Registry of Tuscany to Describe First-line Pharmacotherapy and Survival of Patients with Non-resectable Non-small Cell Lung Cancer from 2009 to 2019

Background: During the last decade treatment guidelines for advanced stage non-resectable Non-Small Cell Lung Cancer (NSCLC) have rapidly changed mainly due to the introduction of new drugs as target- (TT) and immuno-therapies (IT).

Objectives: To describe the first-line pharmacotherapy and survival of non-resectable NSCLC patients between 2009 and 2019 in Tuscany, Italy.

Methods: Patients with a NSCLC diagnosis recorded in the regional pathology registry (PR) of Tuscany between 2009 and 2019 were identified using an ad hoc developed algorithm. The date of the first PR record was the index date (ID). Patients were linked to the regional administrative healthcare database and followed up to June 2020. NSCLC patients with a lung surgery recorded ±6 months from ID and those with a cancer diagnosis in the 5 years before ID were excluded. Patients were thus classified according to first-line treatments recorded during the 4 months following ID in standard chemotherapy (CT), TT, IT, undefined monoclonal antibody therapy or no drugs received. Finally patients were stratified on the basis of histology: squamous, non-squamous and unknown histology. The Kaplan Meyer survival curve for patients receiving a drug treatment was plotted according to histology (i.e. squamous, non-squamous) and year of cohort entry (i.e. 2009-2011, 2012-2014, 2015-2017, 2018-2019).

Results: A total of 4,393 incident patients with unresected primary NSCLC were included in the analysis (63.6% non-squamous, 35.5% squamous, 0.9% unknown histology). Overall, most of patients received CT (52.6%). Approximatively 10% of all patients with non-squamous histology received a TT (1% in 2009; 9.2% in 2019). TT was negligible among squamous patients (0.3%). Overall, 2.5% of patients in the study cohort received IT while 37.5% did not receive any drug during the 4 months following ID. Median survival was 355 days for non-squamous and 304 days for squamous cases. The 5-year survival estimates in 2015-2017 period were 11% for non-squamous and 7.2% for squamous patients while in 2009-2011 were 5.1% and 5.4%, respectively.

Conclusions: Chemotherapy was the most used first-line regimen. In patients with non-squamous NSCLC TT use increased over the study period while the use of IT was observed in the last three years of the study. Survival appeared to improve slightly over the study period in NSCLC patients and in particular for those with non-squamous histology.