Trends in the prescription of immune checkpoint inhibitors for non-small cell lung cancer in the Netherlands from 2016 to 2020, a national cancer registry analysis.

Background: Lung cancer is the leading cause of cancer mortality globally, with a 5-year survival rate of 10-20%. In recent years, immune checkpoint inhibitors (ICIs) have significantly improved overall survival (OS) in patients with lung cancer. The approval of nivolumab in 2015 marked a milestone in non-small cell lung cancer (NSCLC) treatment, leading to ongoing trials and approvals of new ICI drugs that have reshaped treatment strategies and clinical outcomes for patients with lung cancer. This study aims to describe ICIs prescription trends for NSCLC in the Netherlands and their association with survival. We compared our results with data from randomized controlled trials (RCTs).

Methods: We analyzed ICIs prescription trends and their relationship with survival using national-level data from the Netherlands Cancer Registry (NCR) for first-line treatments from 2016-2020. Additionally, we performed a secondary analysis using data from the Oncological Life Study (OncoLifeS) for any-line treatments. Descriptive statistics and annual percentage change (APC) assessed trends in patient and treatment characteristics. OS analyses were performed.

Results: In the Netherlands (2016-2020), the proportion of first-line ICI-treated NSCLC patients significantly increased from 1.1% to 54.9% (APC =14.5%, P=0.002), replacing chemotherapy monotherapy. Stage III ICI-treated patients' proportion increased (APC =3.5%, P=0.034), while the proportion of ICI-treated patients with ≥50% programmed death-ligand 1 (PD-L1) expression decreased (APC =-13.82%, P=0.04). Two-year OS was 25.9%. Median OS remained stable, increasing from 2016 to 2018 (16.6 to 19.4 months) and declining slightly in 2019 and 2020 (17.3 and 16.6 months, respectively). In the secondary analysis, median OS varied by treatment line, being 18.8, 9.4 and 7.5 months for first-, second- and third-line treated patients respectively.

Conclusions: Using real-world data, we determined that ICI-based therapies replaced chemotherapy-only schemes as first-line treatment for NSCLC. Our survival data are comparable with data from RCTs on first-line ICI-treated NSCLC. Median OS of ICI treated patients has remained stable, with small decreases in recent years possibly attributed to the proportional decrease of individuals with high PD-L1 expressions in treatment regimens. Further-line treatments are associated with lower survival.