Utilization of EGFR, ALK, and BRAF Inhibitors in the Treatment of Lung Cancer in Germany

Background

There is a lack of real-world data on the use of targeted cancer drugs requiring molecular tumor diagnostics in the treatment of lung cancer in Germany.

Aims

We aimed to characterize the use of such drugs in lung cancer patients based on longitudinal analyses.

Methods and Results

Using the GePaRD database (claims data from ~20% of the German population) we identified lung cancer patients diagnosed in 2016 based on a previously developed algorithm and followed them until death, end of continuous insurance, or end of 2019. We determined the proportion of patients treated with at least one of the drugs under study (EGFR, ALK, and BRAF inhibitors). We described these patients regarding demographic characteristics, treatment patterns, and overall survival. We included 7833 incident lung cancer patients. Of these, 392 (5%) were treated with one of the drugs under study, the majority (62%) being female. In 314 out of the 392 patients (80%), the first dispensation was an EGFR inhibitor (afatinib: 54%, erlotinib: 33%), and in 72 patients (18%), it was an ALK inhibitor (crizotinib: 90%). The proportion of patients treated with these drugs was 4.8% in West Germany and 6.2% in East Germany. About half of these patients had chemotherapy before targeted therapy. Median overall survival after the first targeted therapy was 22 months.

Conclusion

One twentieth of lung cancer patients diagnosed in 2016 in Germany received at least one EGFR, ALK, or BRAF inhibitor during follow-up. The proportion was higher in East than in West Germany. As the development and availability of new cancer drugs is a dynamic area, regularly updated utilization studies—ideally as cross-country-comparisons—are required.