Trends in the prescription of systemic anticancer therapy and mortality among patients with advanced non-small cell lung cancer: a real-world retrospective observational cohort study from the I-O optimise initiative.

Objectives To assess how a decade of developments in systematic anticancer therapy (SACT) for advanced non-small cell lung cancer (NSCLC) affected overall survival (OS) in a large UK University Hospital. Design Real-world retrospective observational cohort study using existing data recorded in electronic medical records. Setting A large National Health Service (NHS) university teaching hospital serving 800 000 people living in a diverse metropolitan area of the UK. Participants 2119 adults diagnosed with advanced NSCLC (tumour, node, metastasis stage IIIB or IV) between 2007 and 2017 at Leeds Teaching Hospitals NHS Trust. Main outcomes and measures OS following diagnosis and the analysis of factors associated with receiving SACT. Results Median OS for all participants was 2.9 months, increasing for the SACT-treated subcohort from 8.4 months (2007–2012) to 9.1 months (2013–2017) (p=0.02); 1-year OS increased from 33% to 39% over the same period for the SACT-treated group. Median OS for the untreated subcohort was 1.6 months in both time periods. Overall, 30.6% (648/2119) patients received SACT; treatment rates increased from 28.6% (338/1181) in 2007–2012 to 33.0% (310/938) in 2013–2017 (p=0.03). Age and performance status were independent predictors for SACT treatment; advanced age and higher performance status were associated with lower SACT treatment rates. Conclusion Although developments in SACT during 2007–2017 correspond to some changes in survival for treated patients with advanced NSCLC, treatment rates remain low and the prognosis for all patients remains poor.