Trends in the use of immune checkpoint inhibitors for non-small cell lung cancer in the Netherlands from 2016 to 2020, a national cancer registry analysis

Abstract

Abstract Introduction This study aims to describe immune checkpoint inhibitors’ (ICIs) prescription trends for Non-small cell lung cancer (NSCLC) in the Netherlands and their association with survival. We compared our results with data from randomized controlled trials (RCTs). Methods We analyzed ICIs prescription trends and their relationship with survival using national-level data from the Netherlands Cancer Registry (NCR) for first-line treatments from 2016–2020. Additionally, we performed a secondary analysis using data from the Oncological Life Study (OncoLifeS) for any-line treatments. Descriptive statistics and annual percentage change (APC) assessed trends in patient and treatment characteristics. Overall survival analyses were performed. Results In the Netherlands (2016–2020) the proportion of first-line ICI-treated NSCLC patients significantly increased from 1.1–54.9% (APC = 14.5%, p = 0.002), replacing chemotherapy monotherapy. Stage III ICI-treated patients' proportion increased (APC = 3.5%, p = 0.034), while the proportion of ICI-treated patients with ≥ 50% PD-L1 expression decreased (APC=-13.82%, p = 0.039). 2-year overall survival (OS) was 25.9%. Median OS increased from 2016 to 2018 (16.6 to 19.4 months) and declined in 2019 and 2020 (17.3 and 16.6 months, respectively). In the secondary analysis, median OS varied by treatment line, being 18.8, 9.4 and 7.5 months for first-, second- and third-line treated patients respectively. Conclusion Using real-world data, we determined that ICI-based therapies replaced chemotherapy-only schemes as first-line treatment for NSCLC. Our survival data is comparable with data from RCTs on first-line ICI-treated NSCLC. The decreased survival over time may be attributed to the proportional decrease of individuals with ≥ 50% PD-L1 expression in treatment regimens. Further-line treatments are associated with lower survival.