Treatment patterns and outcomes in advanced and metastatic lung cancer in France: Results from the Epidemiological Strategy and medical Economics (ESME) database lung cancer in France

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BACKGROUND: Lung cancer is the main cause of cancer-related death, with recent paradigm shifts including optimized staging, identification of molecular subsets with access to targeted agents, and replacement of chemotherapy by immunotherapy as the backbone of treatment. The Lung Cancer part of the Epidemiological Strategy and Medical Economics (ESME) research program was launched to collect individual data from all consecutive patients treated for lung cancer since 2015 in a network of 38 health facilities in France. METHODS: Main objectives included the description of the treatment patterns and outcomes of patients diagnosed with lung cancer in the database. Univariable and multivariable analyses on overall survival were performed using the Logrank test and the Cox proportional hazards model. RESULTS: Among 52,514 patients included in the advanced and metastatic lung cancer (AMLC) cohort, 45,232 (86%) had non-small cell lung cancer (NSCLC), and 6,301 (12%) had small-cell lung cancer (SCLC). Among those, 34% in the NSCLC cohort and 42% in the SCLC cohort did not receive second-line. In the NSCLC cohort, immune checkpoint inhibitor (ICI)-based therapies became the most commonly used first-line option from 2020 onwards. After a median follow-up of 58.1 (95%CI 57.1-59.0) months, the median OS was 15.7 (95%CI 15.4-16.0) months for patients with NSCLC, and 11.0 (95%CI 10.7-11.3) months for those with SCLC. At multivariable analyses, age, stage, histologic subtype for NSCLC remained significantly associated with OS, as well as gender, ECOG performance status and presence of brain metastases, both for NSCLC and SCLC. CONCLUSIONS: The ESME database provides a realistic overview of lung cancer management in France and a reliable assessment of treatment patterns in real-world setting, which constitutes essential evidence to complement data from clinical trials, and highlights unmet needs in treatment sequences.

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