Current real-world evidence on characteristics and treatment patterns of lung cancer in the single cancer center in the Czech Republic - data from Masaryk Memorial Cancer Institute registry in 2018- 2022.

Background: Lung cancer (LC) represents the leading cause of cancer-related deaths in the Czech Republic. Over the past decade, there have been notable advancements in LC treatment based on findings from controlled clinical trials (CTs). However, patients enrolled in CTs may not fully represent the diversity of real-world patient populations from routine clinical practice. To address this gap, we designed an observational retrospective study to describe the real-world evidence of LC treatment from a single-center registry.

Patients and methods: We present data from an observational, retrospective study based on electronic medical records of adults with LC registered at Masaryk Memorial Cancer Institute between 2018 and 2022. The primary objective was to set up a registry including patient attributes, clinical characteristics, pathological data, treatments, survival outcomes, and adverse events. The patients were identified based on ICD-10 code C34. The study population was further limited to those with verified histological subtypes - non-small cell LC (NSCLC) and small cell LC (SCLC). The primary treatment cohort included patients diagnosed or initiated on primary treatment during the study period. The non-curative systemic therapy cohort consisted of patients who received any systemic anti-cancer therapy with non-curative intent even if being diagnosed before 2018.

Results: A total of 1,382 patients were identified with the ICD-10 code C34. The eligible cohort included 1,172 LC patients, of whom 877 (75%) were diagnosed during the study period. Out of 827 LC patients included in the primary treatment cohort, 723 (87%) were diagnosed with NSCLC. At LC diagnosis, 56% of patients had stage IV disease. The median follow-up of the primary treatment cohort was 40.4 months, and the five-year overall survival rate was 20% for NSCLC patients and 8.2% for SCLC patients. A total of 495 NSCLC and 79 SCLC patients received systemic anti-cancer therapy at any line of treatment. In NSCLC patients, 61 (12%) received next generation sequencing mutation testing, 106 (30%) were identified with PD-L1 ≥ 50%, and 170 patients had evidence of particular driver oncogene mutation. Based on the testing, a total of 154 NSCLC patients received target therapy, and 86 NSCLC patients received immunotherapy as monotherapy or in combination with chemotherapy in the first line.

Conclusion: The presented descriptive study of a consecutive cohort of LC patients from one cancer center over a five-year period (2018-2022) indicates the potential of LC patient registry. The LC registry, with its prospective development including an entire-country extension, provides a tool for real-world evidence that complements data from the registration and post-registration CTs, offering invaluable insights derived from clinical practice.