Comparative Effectiveness of Second-Line Treatment for Non-Small Cell Lung Cancer (nsclc) among Patients 70 Versus < 70 Years of Age.

e19018 Background: Until 2014 guidelines for the second-line treatment of NSCLC included pemetrexed, docetaxel, gemcitabine, and erlotinib. Outcomes among patients (pts) ≥ 70 years are not well understood. This retrospective study describes second-line treatments and compares their outcomes in real-world clinical settings by age in the US. Methods: IMS Oncology patient-level EMR data (1/2007-6/2014) were used for this study. Eligible pts were those with a diagnosis of lung cancer (ICD-9-CM 162.2-162.9) from 1/2007-6/2013 who received at least 2 lines of treatment. Baseline demographic and treatment data were analyzed using descriptive statistics. Survival analyses by age cohort were adjusted using propensity-score matching. Pts alive at the end of the database were censored in the survival analyses. Results: There were 10,634 eligible pts: the mean age was 66.4 (SD = 9.9), 54% were male and 86% of the 40% with stage data were initially diagnosed with stage III-IV disease. Of all eligible pts, 4,418 (41.5%) were age ≥ 70 and survived a median of 6.8 months (95% CI: 6.7-6.9); pts < 70 survived a median of 6.9 months (95% CI: not estimable). The most common initial second-line treatments used in the ≥ 70 versus < 70 groups were pemetrexed (16.6% vs 16.7%, p = 0.82), carboplatin + paclitaxel (11.6% vs 11.7%, p = 0.92), erlotinib (10.2% vs 7.1%, p < 0.001), gemcitabine (6.5% vs 4.6%, p < 0.001) and docetaxel (6.4% vs 7.3%, p = 0.09). There were significantly better survival outcomes in the < 70 cohort for docetaxel (p ≤ 0.001), carboplatin + gemcitabine (p = 0.03) and bevacizumab + pemetrexed (p < 0.001) compared to patients ≥ 70 based on the log-rank test. Other regimens (e.g. gemcitabine, carboplatin + taxane) were not significantly different. Conclusions: There is great variation in treatment for NSCLC in the second line, with no single regimen accounting for more than 20% of the 2nd line population. Pts ≥ 70 were more likely to receive erlotinib or gemcitabine than those < 70. Survival outcomes were comparable between age groups; however, there were statistically significant differences in survival among several treatment regimens received by age group.