There were considerable shifts in the treatment of advanced-stage non-small cell lung cancer (NSCLC) from 2000 to 2011 accompanied with modest gains in survival and total Medicare spending, according to a study published in the Journal of Clinical Oncology.1

Various agents, including biologic targeted agents, have been approved for advanced NSCLC over the last decade, but there have been limited data on their use and associated survival and spending. Therefore, researchers sought to use linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data to assess infusion and oral antineoplastic agents prescribed for newly diagnosed advanced-stage NSCLC over a 12-year period.

For the study, researchers analyzed data from 22,163 older patients with newly diagnosed advanced-staged NSCLC who were treated with antineoplastic agents between 2000 and 2011. Investigators estimated the adjusted percentage of patients who received each agent, days while on treatment, survival, and spending in the 12 months after diagnosis.

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Results showed a substantial shift in treatment over the study period with rapid adoption of pemetrexed (39.2%), erlotinib (20.3%), and bevacizumab (18.9%). Investigators observed a decline in paclitaxel (38.7%), gemcitabine (17.0%), and vinorelbine (5.7%; all P <.05).

Researchers found that the average total days on therapy increased from 103 days to 108 days, with patients who received bevacizumab, erlotinib, or pemetrexed having the longest average treatment durations. The average treatment duration for patients receiving these agents was approximately 146 days compared with 75 days for those who did not receive these agents.

Investigators observed modest but statistically significant median survival gains of 1.5 months over the 12-year period (P <.001).

Importantly, approximately 44% of patients received antineoplastic agents in the last 30 days of life throughout the study period, regardless of year of diagnosis. Current guidelines recommend treating patients until evidence of disease progression, after which time patients may live only a few weeks.

The study further demonstrated that acute inpatient spending declined by approximately 20%, while outpatient spending rose 23%.


1. Bradley CJ, Yabroff KR, Mariotto AB, Zeruto C, Tran Q, Warren JL. Antineoplastic treatment of advanced-stage non–small-cell lung cancer: treatment, survival, and spending (2000 to 2011). J Clin Oncol. 2017 Jan 3. doi: 10.1200/JCO.2016.69.4166. [Epub ahead of print]