Treatment patterns and outcomes of later-line therapy in advanced non-small cell lung cancer with unknown or no actionable genomic alterations: a multicenter real-world study in China (RECAP study).

Abstract

Background: Although first-line immunotherapy has expanded treatment options for advanced non-small cell lung cancer (NSCLC) without actionable genomic alterations (AGA), real-world patterns and outcomes of later-line therapies remain poorly defined. This study aimed to characterize these later-line treatment patterns and evaluate their clinical outcomes.

Methods: The RECAP study retrospectively analyzed 383 Chinese patients with advanced NSCLC who had unknown or no AGAs and received second-line (2L; n=302) or third-line (3L; n=81) therapy. Treatment regimens were classified as anti-angiogenic (A), chemotherapy (C), chemotherapy-based combinations (C+), immunotherapy (I), immunotherapy-based combinations (I+), and other regimens (O).

Results: Treatment patterns, real-world progression-free survival (rwPFS), time to treatment discontinuation (TTD), time to next treatment or death (TTNT), and adverse events (AEs) were collected. In the 2L-enrolled group, the most common regimen was I + C (30.5%), while A + C (21.0%) predominated in the 3L-enrolled group. In the 2L-enrolled group, I + C regimen remained common across treatment lines, while the use of the A regimen increased in the 3L. Median rwPFS was 7.0 months [95% confidence interval (CI): 5.9-9.6] for 2L therapy in the 2L-enrolled group and 7.2 months (95% CI: 5.0-12.8) for 3L therapy in the 3L-enrolled group. I + A achieved the longest rwPFS for 2L therapy in the 2L-enrolled group (13.7 months), and I + A + C for 3L in the 3L-enrolled group (13.6 months). AEs occurred in 13.1% of patients.

Conclusions: The RECAP study underscores the prominent role of I+ regimens in later-line settings, with I + C commonly used across treatment lines. These I+ regimens demonstrated favorable clinical outcomes in both 2L and 3L enrolled patients. However, these findings should be interpreted with caution because of the retrospective design, treatment heterogeneity, and exploratory nature of the analyses.