Study Objectives:National prevalence estimates for idiopathic hypersomnia (IH) are difficult to obtain. This study estimated the diagnosed IH prevalence among US adults. Methods:Symphony Integrated Dataverse claims (01/2015-12/2023) were analyzed. Eligible patients were aged ≥18 years with at least one medical/prescription claim in the year of interest (2019-2023) and prior year. IH was defined by ≥1 medical claim with an IH diagnosis code. Prevalence was estimated among all eligible patients in two ways: annual (IH diagnoses during year of interest) and all-time (IH diagnoses looking back all-time in the database from 2015 through year of interest). Age- and sex-adjusted prevalence estimates were also calculated using the US Census Bureau. Results:Over 179, 182, 193, 205, and 198 million adults were assessed for diagnosed IH prevalence in each respective year 2019-2023. Unweighted annual prevalence of diagnosed IH from 2019 to 2023 was 12.1, 11.1, 11.0, 10.5, and 11.1 per 100 000 persons, respectively. Unweighted all-time lookback prevalence of diagnosed IH from 2019 to 2023 was 32.7, 37.3, 40.6, 43.3, and 49.0 per 100 000 persons, respectively. From 2019 to 2023, estimated standardized numbers of US adults diagnosed with IH were 30 563, 27 975, 27 859, 26 624, and 28 754 based on annual prevalence, and 82 027, 93 768, 101 766, 107 763, and 124 905 based on all-time prevalence. Conclusions:Annual prevalence estimates (i.e. proportions of individuals with diagnosed IH during each year of interest) remained consistent across the follow-up period, ranging from 10.5 to 12.1 per 100 000 persons, signifying the rarity of the diagnosis.

The Coalition to Advance Real-World Evidence through Randomized Controlled Trial Emulation (CARE) Initiative seeks to advance understanding of when real-world data (RWD) can generate valid treatment effectiveness estimates by emulating completed oncology randomized controlled trials (RCTs). A prerequisite for meaningful RCT emulation insights is the identification and use of RWD with sufficient fitness to satisfy RCT-specific data elements. We conducted a systematic, multi-stage feasibility assessment of six commercially available US electronic health record-based RWD sources across 23 candidate oncology RCTs. Each potential RCT-RWD combination was first screened for availability of the RCT indication, outcomes, and sample size ≥ 1.5-times enrollment for each trial arm. Combinations passing this screen underwent more detailed evaluation of RCT design elements including eligibility criteria, outcomes, and potential confounders. Each data element was rated with respect to availability, missingness, and validity. Final feasibility determination was informed by ratings of essential element capture and refined sample size estimates. Of 54 candidate RCT-RWD combinations assessed, nine advanced to detailed feasibility assessment and three were selected for emulation protocol development. Fit-for-emulation constraints included complex eligibility criteria, biomarker requirements, performance status requirements, and outcome ascertainment. These findings highlight the importance of systematic feasibility evaluation before conducting emulations and may inform data selection for future RWD studies in oncology. Data fitness for oncology RCT emulation could be improved by linking high-quality, oncology-specific RWD sources to broader EHR and claims data sources or through customized data abstraction.

AIM:Assess real-world outcomes of lurbinectedin and other second-line treatments (OST) in adults with small cell lung cancer that progressed on/after chemotherapy. PATIENTS & METHODS:US-based electronic medical data from Flatiron Health (01/01/2013-03/31/2022) were used. Baseline characteristics, including chemotherapy-free interval (CTFI), in patients receiving lurbinectedin or OST were balanced using propensity score (PS) overlap weighting. RESULTS:Before PS-weighting, median (95% confidence interval [CI]) real-world progression-free survival (rwPFS) was 2.46 months (2.07-2.73), and real-world response rate (rwRR) was 27.5% (23.1-32.4) in 374 eligible lurbinectedin-treated patients. After PS-weighting, median rwPFS was 2.73 months (2.33-3.32) and 2.53 months (2.23-2.99) in 291 lurbinectedin-treated patients and 261 OST-treated patients, respectively; rwRR was 30.9% and 31.8% (relative risk, 0.97). Lurbinectedin demonstrated numerically improved median rwPFS (3.61 versus 3.02 months) and rwRR (38.7% versus 36.1%) versus OST in patients with CTFI ≥90 days but not in patients with CTFI <90 days (2.00 months both; 20.5% versus 26.1%). Lurbinectedin-treated patients reported less grade ≥3 thrombocytopenia (11.7%) and anemia (6.5%) versus OST (27.2% and 20.3%, respectively); prevalence by CTFI status were similar. CONCLUSION:Lurbinectedin demonstrated comparable real-world effectiveness with OST with a favorable safety profile; however, these findings are limited by small sample size.

BACKGROUND:This real-world study describes the treatment landscape evolution after targeted therapy approval and associated survival outcomes for previously untreated metastatic triple-negative breast cancer (mTNBC) in the United States. PATIENTS AND METHODS:This retrospective analysis used de-identified electronic health record-derived data of patients diagnosed with mTNBC (January 2011-July 2022; index date was first-line [1L] treatment start date). Patient characteristics, treatment patterns, real-world overall survival (rwOS), and time to next treatment or death (TTNTD) were determined. Outcomes before (2011-2017, early cohort) and after (2018-2022, late cohort) targeted therapy approval were evaluated. RESULTS:Among 2004 eligible patients, 21% were classified as Black, 13% had Eastern Cooperative Oncology Group performance status ≥2, and 63% were diagnosed with recurrent disease; median age was 60 years. First-line chemotherapy-only (single- and multiple-agent chemotherapy) use decreased with the introduction of targeted therapies from 96% before 2018 to 65% between 2019 and 2022. From 2019, 33% of patients received programmed death-(ligand) 1 inhibitor-based regimen; ~2% received poly (ADP-ribose) polymerase inhibitors. Median 1L treatment duration was 2.6 months and this did not change over time. Of all 1L patients, 34% died before second-line (2L) and 51% subsequently received 2L treatment. Median (95% CI) 1L rwOS and TTNTD were 11.3 (10.7-12.0) months and 4.3 (4.1-4.6) months, respectively. Median 1L 5-year survival [95% CI] showed statistically significant but small improvement from the early (10.9 [10.3-11.6] months) to late cohort (11.9 [10.7-13.1] months; HR [95% CI], 0.87 [0.78-0.96]). CONCLUSION:This analysis demonstrated that, despite changes in care over time, survival improvements were not clinically meaningful; thus, a substantial unmet need for more efficacious treatments in previously untreated patients with mTNBC remains.

Abstract Introduction Idiopathic hypersomnia (IH) is a rare neurologic disorder that can cause debilitating symptoms, including excessive daytime sleepiness, severe sleep inertia, prolonged nighttime sleep, long and unrefreshing naps, and cognitive dysfunction. Research reporting the burden of IH is scant. The objective of this study was to estimate the diagnosed prevalence of IH among US adults between 2019 and 2021. Methods Symphony Integrated Dataverse® administrative claims between November 2015 and December 2021 were analyzed. Eligible patients were aged ≥18 years and had 1 medical or prescription claim in the calendar year of interest (2019, 2020, or 2021) and in the year prior. Diagnosed prevalence included all IH cases observed in eligible patients through the last day of the year of interest. IH cases were defined as eligible patients with ≥1 medical claim containing an IH diagnosis code in any position before or during the calendar year of interest, and no history of cataplexy. Unweighted prevalence estimates were reported per 100,000 persons with 95% confidence intervals (CIs). Age- and sex-adjusted prevalence estimates were calculated using 2019 US Census Bureau data. Results Over 158, 168, and 187 million adults were eligible for assessment of diagnosed prevalence of IH in 2019, 2020, and 2021, respectively. The unweighted diagnosed prevalence of IH was 32.12 per 100,000 persons (CI: 31.84, 32.40), 35.71 per 100,000 persons (CI: 35.43, 36.00), and 37.03 per 100,000 persons (CI: 36.75, 37.30) in 2019, 2020, and 2021, respectively. The estimated standardized numbers of US adults diagnosed with IH were 80,603 (CI: 80,048, 81,161), 89,539 (CI: 88,954, 90,127), and 92,139 (CI: 91,545, 92,736) in 2019, 2020, and 2021, respectively. Conclusion To our knowledge, this is the most recent study to estimate diagnosed prevalence of IH in US adults. It is uncertain what proportion of IH cases remain undiagnosed considering the under-recognition of this condition, low utilization of sleep testing, and concerns over the reliability of multiple sleep latency testing. Furthermore, recent studies suggest only a subset of patients with IH actively seek medical care for their condition. Given its impact on patients’ lives, further research to improve surveillance of IH symptoms is needed. Support (if any) Jazz Pharmaceuticals.

Lurbinectedin, a selective inhibitor of oncogenic transcription, received accelerated approval from the US FDA in June 2020 for the treatment of adult patients with metastatic small cell lung cancer (SCLC) with disease progression on or after platinum-based chemotherapy. This study evaluated real-world (RW) effectiveness and adverse events of special interest (AESI) including neutropenia, thrombocytopenia, anemia, and febrile neutropenia, in patients with SCLC who received lurbinectedin monotherapy in the second-line (2L) setting.

Despite current treatments, patients with myasthenia gravis (MG) experience unpredictable and inadequately controlled symptoms, lending to variability in the clinical and economic burden of disease. However, limited data are available on MG healthcare costs, and specifically, no data on patients initiating second-line therapy. Using claims data from the IBM (R) MarketScan (R) database, we assessed patient characteristics, healthcare resource utilization, and costs among MG patients initiating second-line therapy, and identified potential factors associ-ated with high healthcare costs over a two-year follow-up period. We identified 1498 patients, of whom 49% and 31% received chronic steroids and non-steroidal immunosuppressants (NSISTs) as their second-line therapy, respectively. During follow-up, 49% experienced >= 1 MG exacerbation. Among all patients, mean all-cause total healthcare cost was $106,821 per patient during follow-up, with $88,040 and $18,780 attributed to medical and pharmacy costs, respectively. In a multivariable analysis, variables significantly associated with high cost included use of high-dose steroids, chronic intravenous immunoglobulin (IVIg, >= 6 cycles), and 1 and >= 4 (but not 2-3) MG exacerbations in the first year after second-line therapy initiation. Any number of exacerbations were associated with high cost in a univariable analysis. A stratified cost analysis showed that patients with >1 exacerbation, >= 1 treatment switch, and high-dose steroid use in this first year experienced $198,487, $114,037, and $79,752 mean MG-related total healthcare spend during follow-up, respectively. These data suggest that patients receiving chronic IVIg or NSISTs for MG experience significant economic burden. Disease characteristics including exacerbation and treatment history may be an indicator of future high costs.

Lurbinectedin received accelerated approval for metastatic small cell lung cancer (SCLC) patients with disease progression on or after platinum chemotherapy based on the results of a single-arm phase 2 study. This study compares overall response rate (ORR) and overall survival (OS) in the lurbinectedin trial to other treatments from a real-world external control arm. The data in this abstract was accepted as an e-abstract at ASCO 2022. All rights reserved.

mTNBC is a clinically aggressive disease associated with poor prognosis with a median overall survival (OS) after metastasis of 15.5 mo. Despite improved survival from recent first-line (1L) therapy (Cortes et al. NEJM. 2022), most patients have disease progression. This study aims to describe the unmet need in previously untreated patients with mTNBC in the US. This retrospective observational analysis used Flatiron Health de-identified electronic health record data. Pts (aged ≥ 18 years) with mTNBC (defined by American Society of Clinical Oncology/College of American Pathologists guidelines: HER2 IHC0, 1, or 2/ISH-negative; ER/PR negative) who initiated 1L treatment (tx) from January 2011 to May 2022 were included. Pts receiving HER2-targeted or hormone tx, or a clinical trial drug were excluded. Real-world (rw)OS and time to next tx or death (TTNTD) were calculated using Kaplan-Meier method. The study included 1764 pts (Table). Median time from diagnosis to 1L tx was 0.85 mo. Most pts received CT mono- (46.9%) or combination (36.7%) therapy (Table). Of the 1764 pts, 907 (51%) initiated second (2)L tx (33% had died) and 453 (26%) initiated 3L tx (35% had died). Median rwOS (95% CI) was 11.2 mo (10.7-12.0) with a 1- and 2-year survival rate (95% CI) of 47.5% (45.1-49.9) and 23.9% (21.7-26.1), respectively. Median TTNTD (95% CI) for 1Ltx was 4.3 mo (4.1-4.5). Stratified analyses by year of mBC diagnosis, tx type, and other factors will be presented.Table: 396PCharacteristicPatient population N = 1764Median age, (IQR), years60 (51, 70)Sex, female, %99.7Race, % White Black57..4 20.8Eastern Cooperative Oncology Group performance status ≥ 2, %12.4De novo mBC, %30.21L treatment, % CT monotherapy Capecitabine Taxanes Other CT monotherapy46.9 18.4 16.9 11.6CT combination Carboplatin/gemcitabine Cyclophosphamide/doxorubicin Other CT combination PD-(L)1 inhibitor-based regimen36.7 9.8 8.6 18.3 14.6Poly (ADP-ribose) polymerase inhibitor- based regimen0.85 Open table in a new tab In this rw study, most pts received CT as 1L therapy. Clinical outcomes were poor, and many pts did not receive tx after 1L due to high attrition rates between lines of therapy. These data confirm the unmet need for more efficacious tx options for pts with mTNBC in the 1L setting.

Aims To assess real-world use of emicizumab in adult people with hemophilia A (PwHA) without inhibitors including healthcare resource utilization (HCRU) and costs. Materials and methods Adult, male PwHA without inhibitors initiating emicizumab (index date) were identified using IBM MarketScan after 4 October 2016. Patients were required to have continuous health insurance coverage for >= 180 days prior to and >= 90 days after index date and have >= 90 days of continuous use of emicizumab. Patients were followed until treatment gap, disenrollment, or end of data. Results were reported overall and among a subgroup with prior factor VIII (FVIII) prophylaxis. Emicizumab use, concomitant FVIII treatment use, HCRU, and costs were assessed separately over baseline, the emicizumab induction period, emicizumab maintenance period, and annualized. Results Among the 71 emicizumab patients (FVIII prophylaxis subgroup: 52) included in the study, the mean age was 35 (subgroup: 34) years and mean follow-up was 12 (subgroup: 11.1) months. At baseline, the annualized mean total healthcare cost was $532,948 (subgroup: $645,727). After emicizumab initiation, per-patient-per-month (PPPM) HCRU was higher in the emicizumab induction period compared to the maintenance period with higher monthly FVIII fills/in-office administrations (0.37 vs 0.17), non-FVIII outpatient visits (2.23 vs 1.55), and emergency department visits (0.06 vs 0.03). The FVIII prophylaxis subgroup yielded similar HCRU trends. Hemophilia treatment costs accounted for over 95% of total healthcare costs. The annualized mean cost was $50,491 (subgroup: $61,512) for concomitant FVIII treatment and $777,171 (subgroup: $793,168) for emicizumab and concomitant FVIII treatment for the first year of emicizumab treatment. Conclusion This study represented experience with emicizumab after the approval for PwHA without inhibitors. The study cohort may not be representative of all PwHA taking emicizumab. The findings highlight the continued burden of treatment and healthcare cost for PwHA without inhibitors despite advances in treatment options.

e20619 Background: Lurbinectedin monotherapy is currently approved for the treatment of adult patients with metastatic small cell lung cancer (SCLC) with disease progression on or after platinum-based chemotherapy based on the results of a single-arm phase 2 basket trial. The current study established real-world comparator arms (RWCAs) to enable retrospective comparison of the efficacy of lurbinectedin from the trial, notably overall survival (OS) and overall response rate (ORR), to other standard of care treatments. Methods: This exploratory study consisted of two arms, where the 1st arm was the lurbinectedin trial arm (LTA) comprised of data from the SCLC cohort of the trial (NCT02454972) and the 2nd arm was an RWCA sourced from ConcertAI electronic medical records in the US (2010 to 2019). Relevant inclusion and exclusion criteria from the trial were applied to the RWCA to ensure comparability at baseline. Given the absence of Eastern Cooperative Oncology Group performance status (ECOG) for a sizable portion of patients in the RWCA, two RWCA groups were studied, one that excluded patients with reported ECOG > 2 (RWCA1) and the other that excluded patients with reported ECOG > 2 and missing ECOG (RWCA2). Propensity score (PS) weighting was used to further balance measured baseline characteristics between LTA and each RWCA. OS was defined as the time from treatment initiation to death. Weighted cox regression was used to compare OS. ORR was defined as the percentage of patients with a complete or partial response. A weighted two-sample test of proportions was used to compare ORR. Results: This study included 105 patients in LTA and 121 in RWCA1 (74 in RWCA2). After PS weighting, baseline characteristics were mostly similar between LTA and each RWCA. ECOG was balanced between RWCA2 and LTA but was different between RWCA1 and LTA. A numerical median OS benefit of 3.8 and 4.7 months was observed in LTA, compared to RWCA1 and RWCA2, respectively (see table). Probability of survival was greater in LTA compared to RWCAs at 3 and 6 months. ORR was two-fold higher in LTA compared to RWCA1. Consistent findings were seen for LTA compared to RWCA2. Conclusions: Lurbinectedin monotherapy demonstrated improved median OS, lower risk of death at 3 and 6 months, and higher response rate compared to other standard of care treatments in relapsed/refractory SCLC. Future studies with larger sample size powered to detect statistical differences in OS are warranted.[Table: see text]

Understand healthcare resource use (HCU) and costs for commercially insured patients with epilepsy in United States treated with brivaracetam (BRV) in the 12 months pre- and post-treatment initiation.

Lurbinectedin was approved in the US in June 2020 for the treatment of adult patients with metastatic SCLC with disease progression on or after platinum-based chemotherapy. This study describes RW progression-free survival (rwPFS), time to discontinuation (rwTTD), and time to next treatment or death (rwTTNT/D) in patients treated with lurbinectedin in a RW setting. This study used a cohort of 2L SCLC patients treated with single-agent lurbinectedin in the nationwide Flatiron Health US electronic health record-derived de-identified database from 15/06/20 to 31/03/22. rwPFS, rwTTD, and rwTTNT/D were assessed from start of 2L (index date) until event or censor using Kaplan-Meier methods. Results were evaluated among all patients and the subsets with chemotherapy-free interval (CTFI) ≥ 90 days and ≥ 180 days. CTFI was measured as the time from last platinum therapy dose to progression or start of 2L (in the absence of progression). Of the 396 patients included, 222 (56.1%) had a CTFI ≥ 90 days and 49 (12.4%) had a CTFI ≥ 180 days. Median age was 67 years and 84.6% of patients had extensive stage disease at initial diagnosis. 24.5% had an ECOG score of 0, 43.2% had a score of 1, 17.2% had a score of 2, and 14.1% of patients did not have a documented ECOG status in the 30 days prior to index date. Platinum therapy + etoposide with or without immunotherapy was the 1L treatment in >99% of patients. Median rwPFS was longer in the subsets of patients with CTFI ≥ 90 days and ≥ 180 days (overall: 2.5 months, ≥ 90 days: 3.1 months, ≥ 180 days: 4.6 months). Similar trends were seen for rwTTD and rwTTNT/D. Patients treated with lurbinectedin as 2L monotherapy in this RW setting had outcomes consistent with those seen in the phase 2 clinical trial. Lurbinectedin provides an additional treatment option for relapsed SCLC patients, including those with platinum-sensitive disease.Table: 1539POverallCTFI ≥ 90 daysCTFI ≥ 180 daysN (%a)396222 (56.1%)49 (12.4%)Median age at index67.066.067.0ECOG status at indexb097 (24.5%)56 (25.2%)16 (32.7%)1171 (43.2%)93 (41.9%)18 (36.7%)268 (17.2%)39 (17.6%)5 (10.2%)34 (1.0%)1 (0.5%)0 (0.0%)Missing56 (14.1%)33 (14.9%)10 (20.4%)1L Platinumc + etoposide alone59 (14.9%)36 (16.2%)9 (18.4%)1L Platinumc + etoposide + immunotherapy334 (84.3%)184 (82.9%)40 (81.6%)Median time to event (95% CI) (months)rwPFS2.5 (2.2, 2.8)3.1 (2.7, 3.9)4.6 (4.0, 6.2)rwTTD2.5 (2.1, 3.5)3.7 (3.5, 4.1)4.8 (3.6, 5.6)rwTTNT/D3.6 (3.2, 4.1)4.7 (4.1, 5.2)5.8 (4.4, 8.2)a% of overall bAssessed within 30 days prior to index cPlatinum-based chemotherapy. Open table in a new tab

Abstract Real‐world data (RWD) reflecting patient treatment in routine clinical practice can be used to develop external control groups for single‐arm trials. External controls can provide valuable benchmark results on potential comparator drug effectiveness, particularly in rare indications when randomized controlled trials are either infeasible or unethical. This paper describes lessons learned from a descriptive real‐world external control cohort study conducted to provide benchmark data for a single‐arm clinical trial in a rare oncology biomarker driven disease. Conducting external control cohort studies to evaluate treatment effectiveness in rare indications likely will present data and analysis challenges as seen in the example study. However, there are mitigating measures that can be applied in the study design, identification of RWD sources, and data analysis. The lessons learned and reported here with a proposal of an external control study framework can provide guidance for future research in this area, and may be applicable as well in other rare indications. Taking these learnings into consideration, the use of real‐world external controls to contextualize treatment effectiveness in rare indications is a valuable approach and warrants further application in the future.

e20577 Background: Previous studies have investigated overall survival (OS) among small cell lung cancer (SCLC) patients with data through 2015. Using data through mid-2019, this study strives to make the body of studies more current, and to provide more recent data on the baseline characteristics and OS of treated SCLC patients, stratified by stage at diagnosis. Methods: This retrospective cohort study identified adult patients with confirmed SCLC between January 1, 2016 - December 31, 2018 that initiated anti-cancer treatment using real-world data from electronic medical records (ConcertAI, including data from CancerLinQ, an initiative of the American Society of Clinical Oncology). Exclusion criteria included evidence of other primary cancer at baseline, no initial stage recorded, death prior to diagnosis, or participation in a clinical trial. Patients entered the cohort upon receipt of their first anti-cancer treatment after SCLC diagnosis and were assigned up to three progression intervals to assess overall survival for each progression-based line of therapy. Patients were followed until death, end of data, or end of the study period (June 30, 2019). Kaplan-Meier analyses were conducted to assess median survival time as estimated by the survival curve. Results: Characteristics among the 82 limited stage (LS) and 217 extensive stage (ES) patients at 1L treatment were similar; however, LS patients were slightly older (mean age: LS = 67.5, ES = 66.4), and ES patients had a higher comorbidity score given their metastatic disease status (mean score: LS = 3.9, ES = 7.3). Both groups had very similar ECOG performance scores prior to 1L (ECOG: 0-1 ≅ 40%, 2+ ≅ 25%, Missing ≅ 35%). For the 299 patients that began 1L treatment (LS = 82, ES = 217), median OS time was 8.41 months (LS = 12.35 months, ES = 7.98 months). For the 124 of the 299 patients who progressed and were treated with 2L therapy, median OS time was 4.30 months. For the 44 of the 124 patients that progressed and were treated with 3L therapy, median OS time was 3.88 months. Of the 299 treated patients, 216 died before the end of the study period, representing 57% of the LS patients and 78% of the ES patients. Conclusions: These results reveal a difference in OS between LS and ES patients treated in 1L. The short survival time in patients with later lines of therapy highlights the need for new treatments in 2L and 3L.[Table: see text]

e20576 Background: With emerging treatment options for small-cell lung cancer (SCLC) patients after initial treatment failure, the real-world management of this disease should be assessed. This study aims to describe treatment patterns of real-world SCLC patients in the second-line therapy (2L) and third-line therapy (3L) setting. Methods: This was a descriptive study of real-world data sourced from ConcertAI electronic medical records, including data from CancerLinQ, an initiative of the American Society of Clinical Oncology of adults (age ≥ 18 years) with confirmed SCLC between January 1, 2016 and December 31, 2018. Patients were excluded based on evidence of other primary cancer at baseline, missing stage, death prior to diagnosis, or clinical trial participation. Patients entered the cohort on their SCLC diagnosis date and were followed through three tumor progressions to assess treatment patterns. Treatment patterns were assessed in 2L and 3L. Baseline characteristics were assessed in the 6 months prior to each line. Patients were classified as having unknown treatment if they had a gap in medical records > 90 days or no recorded tumor response or death within 180 days. Results: Overall, 538 patients were identified; 131 with unknown treatment, 108 with no treatment, 299 with 1st line therapy (1L), 124 with 2L, and 44 3L. The majority (76%) of patients were diagnosed in a community hospital setting. The most common comorbidities were chronic obstructive pulmonary disease (2L 25%, 3L 16%), diabetes (2L 15%, 3L 14%), congestive heart failure (2L 7%, 3L 9%), and myocardial infarction (2L 3%, 3L 2%). Radiation therapy was commonly used in 2L and 3L (2L 48%, 3L 43%) as were immunotherapies (2L 23%, 3L 23%). The most common systemic therapy in 2L and 3L was nivolumab (19% and 16%). Topotecan accounted for 11% of patients treated in 2L and 7% of those in 3L. Conclusions: During this treatment era (pre-immunotherapy 1L approval) there were limited treatment options available for SCLC patients. Radiation therapy and immunotherapies were frequently used as 2L and 3L therapy.[Table: see text]