by ecancer reporter Clare Sansom

Lung cancer is the most commonly diagnosed cancer type, with over 1.5 million cases diagnosed worldwide each year. About 85% of lung cancer cases are of non-small cell lung cancer (NSCLC). The prognosis for patients with this disease is still poor, but a number of drugs are now available for both first- and second-line NSCLC therapy that improve survival and quality of life. So far, there has been little analysis of the use of these drugs in second-line therapy. The year-long multi-centre SELECTTION (Survey in European Lung Cancer Evaluating Choice of Treatment and Tolerability In Observed NSCLC) trial was set up to investigate second-line drugs prescribed for this condition in current clinical practice, the times for which they are prescribed, the reasons for their discontinuation and the therapeutic outcomes. Denis Moro-Sibliot from University Hospital, Grenoble, with collaborators from five other European countries participating in the study, has now published a baseline analysis of the patients selected for the study and the second-line treatments planned.

Patients were recruited into the study by informed consent at the point when second-line therapy was about to be initiated. A total of 1012 patients were recruited from 11 countries, almost all in Europe.  The second-line treatment chosen was at the discretion of the physician concerned; 46.2% of patients were prescribed pemetrexed, 22.9% docetaxel, 20.4% erlotinib and 10.5% other treatments. These treatment choices are in line with international guidelines. Patient and tumour characteristics – the latter including tumour histology, staging and metastatic status – were recorded, as was the reason for each treatment choice. Only about 5% of patients, mainly in the erlotinib cohort, were assessed for EGFR status.

Baseline data was analysed using the statistical package SAS. The reason for choosing a particular second-line treatment was seen to vary between the drugs. The most common reason for prescribing pemetrexed was its side effect profile; both docetaxel and erlotinib were chosen most often because of particular patients’ characteristics; and other treatments were most often chosen because of efficacy. Pemetrexed was more commonly prescribed for males and for smokers and former smokers, whereas erlotinib was more commonly prescribed for never-smokers and females.

Patients were classified into four clusters based on patients’ age, gender, smoking status and tumour histology. This revealed that the profile of patients prescribed erlotinib differed from that of patients prescribed other treatments. As well as females and non-smokers, patients diagnosed with adenocarcinoma were more likely to be given this drug than those with squamous cell carcinoma. This is in line with published data and treatment guidelines that suggest that these patients will benefit most from this drug.

This baseline study provides a useful snapshot of current clinical practice in the second-line treatment of non-small cell lung cancer, and indicates that treatment is generally being given in line with both established outcome data and international guidelines. It does, however, have the drawbacks of all observational studies in that detection bias cannot be ruled out. Later publications in this study should establish the duration and relative efficacy of the selected drugs.

Reference

Moro-Sibilot, D., Vergnenegre, A., Smit, E.F., Toy, E., Parente, B., Schmitz, S., Kraaij, K., Visseren-Grul, C., Soldatenkova, V., Arellano, J. and Leteneux, C. (2010). Second-line therapy for NSCLC in clinical practice: baseline results of the European SELECTTION observational study. Current Medical Research & Opinion 26(11), 2661-2672.