Access to new therapies and outcomes in Brazilian patients with metastatic non-small cell lung cancer (mNSCLC).

Abstract

e23310 Background: In the last decade, different agents were incorporated to treatment of mNSCLC, from chemotherapy (CT) alone to tyrosine kinase inhibitors (TKIs), immune checkpoint inhibitors (ICI) and CT + ICI combinations. Treatment decisions rely on access to comprehensive genomic profiling and level of PDL1 expression. Access to drugs and tests are still limited in low- and middle-income countries. We aimed to investigate the evolution of treatment regimens and real-world Overall Survival (rwOS) of patients with mNSCLC in Brazil. Methods: Retrospective study of all patients diagnosed with mNSCLC between Jan 2017 and Sept 2023 and treated at Oncoclínicas & Co, the largest Brazilian private oncology institution. Structured data (demographics and pharmacy registries) were extracted from electronic health records and combined with elements from unstructured sources (biomarkers and treatment line from physician notes) using technology-based abstraction techniques and human curation. Kaplan-Meyer method was used to calculate rwOS from the first regimen to death or the last follow-up. The project was approved by the local Ethics Committee. Results: In total, 1,944 patients were included. Median age was 71 years, 51% were male and 67% were from southeastern region of Brazil. From 2017 to 2019, CT was most used treatment (48%), followed by ICI (30%), TKI (13%), and CT + ICI (8%). From 2020 to 2023, CT was still the most used treatment (34%), followed by CT + IC (30%), ICI alone (18%) and TKI (18%). Median rwOS for all patients was 16.4 months (CI95% 15.3-18.2), with major differences according to first-line treatment regimen: (a) patients who received CT alone had the lowest rwOS (7.77 months, CI95% 6.37-9.2); (b) those exposed to CT + ICI had intermediate rwOS (13.9 months, CI95% 11.9-16.7); (c) comparable to those receiving ICI based on PDL1 high expression (14.1 months, CI95% 11.8-16.7); and (d)while those exposed to TKI had the longest median rwOS (36.5 months, CI95% 26.5-42.5). Conclusions: This real-world study suggests that the adoption of new treatment regimens in mNSCLC has improved outcomes, mainly in biomarker-guided regimens. Although treatment with TKI and ICI shows better rwOS, their adoption is still limited. Chemotherapy alone was the most used treatment modality from 2020 to 2023, which could be explained by limited access to broad molecular testing and reimbursement constraints. Nevertheless, the real-world outcome of mNSCLC patients treated in a private healthcare setting in Brazil is comparable to populations enrolled in pivotal clinical trials.