Integration of Immuno-oncology (IO) Treatments into Routine Clinical Practice for the Treatment of Patients with Advanced or Metastatic Cancers: Analysis of the England National Cancer Registry

Background: Recent approvals of IO treatments for several cancers were expected to substantially impact standard of care and clinical outcomes. Real-world data from patients (pts) with advanced/metastatic cancer provide evidence that complements clinical trial results.

Objectives: To report the most recent treatment patterns and clinical outcomes in 4 open-ended cohorts of pts diagnosed in England with advanced/metastatic cancer for which IO agents have been approved (Merkel cell carcinoma [MCC], non-small cell lung cancer [NSCLC], renal cell carcinoma [RCC], and urothelial carcinoma [UC]) and to describe recent changes in the treatment landscape.

Methods: Cohorts were identified using routine administrative data from the National Cancer Registration and Analysis Service in England. Patient-level linkage was used to extract comprehensive national data on disease (National Cancer Registration Dataset); inpatient, outpatient, and comorbid diagnoses (Hospital Episode Statistics); anticancer radiotherapy (National Radiotherapy Dataset); and systemic anticancer treatments (Systemic Anti-Cancer Therapy Dataset). Adult pts were included following an incident primary diagnosis (index date) of stage III/IV MCC, NSCLC, RCC, or UC between Jan 2013 and Dec 2020. The follow-up period was from the index date to date of death, loss to follow-up, or end of study period (May 2022), whichever was earliest. Overall survival (OS) was estimated by the Kaplan-Meier method.

Results: The study comprised 667 pts with MCC (33.7% stage IV), 118,188 with NSCLC (68.9% stage IV), 25,918 with RCC (55.0% stage IV), and 19,636 with UC (61.5% stage IV). Systemic first-line (1L) treatments for stage III/IV disease were reported for 29.8%, 45.5%, 32.6%, and 32.2% of pts, respectively. Among pts who received systemic treatment, IO use was reported for 49.2% with MCC, 26.8% with NSCLC, 36.1% with RCC, and 21.0% with UC. Compared with the first data cutoff (diagnosis in 2013-2018, followed up to Dec 2019), IO use doubled in the MCC cohort, almost tripled in the NSCLC and RCC cohorts, and increased more than 5-fold in the UC cohort. Among treated pts with MCC, NSCLC, RCC, and UC, respective median OS from 1L initiation was 12.2, 11.4, 15.7, and 14.4 months at this data cutoff vs 9.1, 10.7, 13.4, and 14.0 months in the first data cutoff.

Conclusions: Consistent with clinical guidelines, this nationwide study shows incorporation of IO into routine clinical practice for multiple cancers; however, the proportion of pts who received systemic therapy was relatively low.