Purpose/Objective(s)Prior studies of advanced non-small cell lung cancer (adv NSCLC) in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database have shown that a majority of patients did not receive infused systemic anticancer treatment (SATx). More recently, innovations in SATx have favored patients with nonsquamous (NSQ) histology and have expanded to include oral targeted therapies. This study examines oral and infused SATx by line of therapy (LOT) and histology in a more recent population-based cohort.Materials/MethodsPatients aged ≥66 who had Medicare Parts A/B/D fee-for-service insurance coverage and were diagnosed with stage IIIB/IV NSCLC in 2007-9 were identified in the United States SEER-Medicare data and classified as squamous (SQ), NSQ, or unclassified histology (not otherwise specified [NOS]). We examined patients’ demographic and clinical characteristics, patterns of SATx (chemotherapy, tyrosine kinase inhibitors, and monoclonal antibodies), and the relationship of SATx to histology.ResultsOf 7080 eligible patients, 26% had SQ, 51% had NSQ, and 24% had NOS histology; 28% were stage IIIB and 72% stage IV. Overall, 44% of all patients received at least first-line (1L) SATx (NSQ 46%, SQ 41%, NOS 43%; P=.0013 across all categories and P=.0006 for NSQ vs SQ). Only 19% of all patients received second-line (2L) SATx (NSQ 21%, SQ 16%, NOS 18%; P<.0001 across all categories and for NSQ vs SQ); expressed as a proportion of patients who received 1L, 43% received 2L (NSQ 45%, SQ 37%, NOS 42%; P=.0014 across all categories and P=.0003 for NSQ vs SQ). Eight percent of all patients received a third-line (3L) of SATx (NSQ 9%, SQ 6%, NOS 7%; P=.0019 across all categories and P=.0016 for NSQ vs SQ); expressed as a proportion of patients who received 2L, 40% received 3L (NSQ 41%, SQ 40%, NOS 38%; P=.51 across all categories and P=.73 for NSQ vs SQ). SATx was variable, with 48, 67, and 64 distinct regimens observed in 1L, 2L, and 3L, respectively. Carboplatin-paclitaxel (33%) and erlotinib (14%) were the most common 1L regimens; pemetrexed (2L=20%; 3L=21%) and erlotinib (2L=17%; 3L=20%) were the most common SATxs in 2L and 3L.ConclusionsDespite recent innovations in SATx for adv NSCLC, more than half of patients do not receive 1L SATx, with progressively fewer receiving 2L and 3L. SQ patients are less likely than NSQ patients to receive SATx across all lines, possibly related to fewer options for SQ patients. Purpose/Objective(s)Prior studies of advanced non-small cell lung cancer (adv NSCLC) in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database have shown that a majority of patients did not receive infused systemic anticancer treatment (SATx). More recently, innovations in SATx have favored patients with nonsquamous (NSQ) histology and have expanded to include oral targeted therapies. This study examines oral and infused SATx by line of therapy (LOT) and histology in a more recent population-based cohort. Prior studies of advanced non-small cell lung cancer (adv NSCLC) in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database have shown that a majority of patients did not receive infused systemic anticancer treatment (SATx). More recently, innovations in SATx have favored patients with nonsquamous (NSQ) histology and have expanded to include oral targeted therapies. This study examines oral and infused SATx by line of therapy (LOT) and histology in a more recent population-based cohort. Materials/MethodsPatients aged ≥66 who had Medicare Parts A/B/D fee-for-service insurance coverage and were diagnosed with stage IIIB/IV NSCLC in 2007-9 were identified in the United States SEER-Medicare data and classified as squamous (SQ), NSQ, or unclassified histology (not otherwise specified [NOS]). We examined patients’ demographic and clinical characteristics, patterns of SATx (chemotherapy, tyrosine kinase inhibitors, and monoclonal antibodies), and the relationship of SATx to histology. Patients aged ≥66 who had Medicare Parts A/B/D fee-for-service insurance coverage and were diagnosed with stage IIIB/IV NSCLC in 2007-9 were identified in the United States SEER-Medicare data and classified as squamous (SQ), NSQ, or unclassified histology (not otherwise specified [NOS]). We examined patients’ demographic and clinical characteristics, patterns of SATx (chemotherapy, tyrosine kinase inhibitors, and monoclonal antibodies), and the relationship of SATx to histology. ResultsOf 7080 eligible patients, 26% had SQ, 51% had NSQ, and 24% had NOS histology; 28% were stage IIIB and 72% stage IV. Overall, 44% of all patients received at least first-line (1L) SATx (NSQ 46%, SQ 41%, NOS 43%; P=.0013 across all categories and P=.0006 for NSQ vs SQ). Only 19% of all patients received second-line (2L) SATx (NSQ 21%, SQ 16%, NOS 18%; P<.0001 across all categories and for NSQ vs SQ); expressed as a proportion of patients who received 1L, 43% received 2L (NSQ 45%, SQ 37%, NOS 42%; P=.0014 across all categories and P=.0003 for NSQ vs SQ). Eight percent of all patients received a third-line (3L) of SATx (NSQ 9%, SQ 6%, NOS 7%; P=.0019 across all categories and P=.0016 for NSQ vs SQ); expressed as a proportion of patients who received 2L, 40% received 3L (NSQ 41%, SQ 40%, NOS 38%; P=.51 across all categories and P=.73 for NSQ vs SQ). SATx was variable, with 48, 67, and 64 distinct regimens observed in 1L, 2L, and 3L, respectively. Carboplatin-paclitaxel (33%) and erlotinib (14%) were the most common 1L regimens; pemetrexed (2L=20%; 3L=21%) and erlotinib (2L=17%; 3L=20%) were the most common SATxs in 2L and 3L. Of 7080 eligible patients, 26% had SQ, 51% had NSQ, and 24% had NOS histology; 28% were stage IIIB and 72% stage IV. Overall, 44% of all patients received at least first-line (1L) SATx (NSQ 46%, SQ 41%, NOS 43%; P=.0013 across all categories and P=.0006 for NSQ vs SQ). Only 19% of all patients received second-line (2L) SATx (NSQ 21%, SQ 16%, NOS 18%; P<.0001 across all categories and for NSQ vs SQ); expressed as a proportion of patients who received 1L, 43% received 2L (NSQ 45%, SQ 37%, NOS 42%; P=.0014 across all categories and P=.0003 for NSQ vs SQ). Eight percent of all patients received a third-line (3L) of SATx (NSQ 9%, SQ 6%, NOS 7%; P=.0019 across all categories and P=.0016 for NSQ vs SQ); expressed as a proportion of patients who received 2L, 40% received 3L (NSQ 41%, SQ 40%, NOS 38%; P=.51 across all categories and P=.73 for NSQ vs SQ). SATx was variable, with 48, 67, and 64 distinct regimens observed in 1L, 2L, and 3L, respectively. Carboplatin-paclitaxel (33%) and erlotinib (14%) were the most common 1L regimens; pemetrexed (2L=20%; 3L=21%) and erlotinib (2L=17%; 3L=20%) were the most common SATxs in 2L and 3L. ConclusionsDespite recent innovations in SATx for adv NSCLC, more than half of patients do not receive 1L SATx, with progressively fewer receiving 2L and 3L. SQ patients are less likely than NSQ patients to receive SATx across all lines, possibly related to fewer options for SQ patients. Despite recent innovations in SATx for adv NSCLC, more than half of patients do not receive 1L SATx, with progressively fewer receiving 2L and 3L. SQ patients are less likely than NSQ patients to receive SATx across all lines, possibly related to fewer options for SQ patients.