A significant proportion of newly diagnosed advanced NSCLC patients does not receive a first-line platinum doublet due to unfavorable clinical characteristics.
We retrospectively collected data on 221 EGFR/ALK negative and PD-L1 <50% patients [median age 79 (range 56-92) years, M/F 165(74.6%)/56(25.4%), PS 0/1/≥2 23(10.4%)/94(42.5%)/103(47.1%), adenoK/squamous/large-cell/NOS 107(48.4%)/94(42.5%)/9(4.1%)/11(5%), median of 2 serious comorbidities] with stage IIIB-IV NSCLC treated with a first-line single agent. Clinicians were asked about the criteria according to which treatment selection was made and what percentage of patients did not receive a first-line platinum-based chemotherapy.
A median of 25% (range 10%-30%) of newly diagnosed NSCLC did not receive a first-line platinum combination. The main clinical criteria according to which decision was made were older age (76.5%), comorbidities (72%), low PS (55.2%) and familiar or social issues (10%). Single-agent treatment consisted of gemcitabine (Gem 10%), oral standard vinorelbine (Vin 8.2%), oral metronomic vinorelbine (MetV 78.6%) and other (O 3.2%). Median time-to-progression (TTP) and overall survival (OS) of single agent treatments were Gem 4.5, Vin 4.5, MetV 5, O 5 months and Gem 9, Vin 9, MetV 10, O 10.5 months respectively. Overall grade 3-4 toxicities were lower with MetV (8%) than with Gem (13.6%), Vin (16.6%) and O (14.3%). Median TTP and OS without grade 3-4 toxicity were Gem 5, Vin 4.5, MetV 6.5, O 5.5 months and Gem 10, Vin 10, MetV 12, O 12 months respectively. Dose delays (Gem 41%, Vin 16.6%, MetV 13.8%, O 28.6%) and dose reductions (Gem 31.8%, Vin 33.3%, MetV 17.8%, O 28.6%) were less frequent with MetV.
We confirmed that up to 30% of newly diagnosed advanced EGFR/ALK negative and PD-L1 <50% NSCLC patients do not receive a first-line platinum doublet. Main clinical selection criteria were older age (>70years), comorbidities and low (≥2) PS. An oral treatment was frequently proposed with MetV being the preferred alternative chosen by clinicians due to the excellent safety profile.
The authors.
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All authors have declared no conflicts of interest.