Real-Life Effectiveness Of First-Line Treatments In Nsclc Patients Stage Iiib/Iv- Data From The Czech Tulung Registry

Introduction: Assessment of real-life effectiveness of drugs should be a routine practice. Aims and Objectives: We aimed to analyse real-life effectiveness [measured as overall survival (OS)] of tyrosinkinase inhibitors (TKIs), bevacizumab and pemetrexed as first-line anticancer treatments in patients with non-small cell lung cancer (NSCLC), stage IIIB/IV. We hypothesized that real-life effectiveness of first-line regimens may be lower than reported from clinical trials. Methods: Prospective data from the TULUNG, a Czech multicenter registry of NSCLC patients receiving personalized treatments (2011 to 2018), were used. We analyzed OS in IIIB/IV NSCLC patients treated by erlotinib, afatinib, gefitinib, bevacizumab or pemetrexed (including maintenance) as first-line treatment. The data were compared with OS data from registration study of each drug. Index of real-life effectiveness (IRE) was calculated for each drug (ratio of median OS in our cohort to median OS from clinical trial). Results: Data of 2157 patients analyzed; 62 treated by erlotinib, 147 by afatinib, 325 by gefitinib, 466 by bevacizumab and 1157 by pemetrexed. The observed median OS were: erlotinib 23 months (mo), afatinib 29.3 mo, gefitinib 19.6 mo, bevacizumab 15.8 mo, bevacizumab maintenance 15 mo, pemetrexed 12.2 mo, pemetrexed maintenance 17.5 mo. Calculated IRE for individual regimens were: 1.01 for erlotinib, 1.05 for afatinib, 1.03 for gefinitib, 1.25 for bevacizumab, 1.17 for bevacizumab maintenance, 1.19 for pemetrexed and 1.26 for pemetrexed maintenance. Conclusion: We found similar (even better) effectiveness of first-line drugs compared to clinical trials. Afatinib showed best effect in EGFR+ patients.