DURHAM, NC—Real world results often differ markedly from those seen in clinical trials. In the very real world setting of the VA, does immunotherapy really provide greater benefit than chemotherapy for patients with lung cancer?

Researchers at the Durham VA Healthcare System and the Duke University Health System compared patient characteristics and outcomes for veterans with metastatic non-small cell lung cancer (NSCLC) who received immunotherapy in the first line and those that started treatment with chemotherapy.

The team reviewed records of 4,609 veterans diagnosed with stage IV NSCLC between 2012 and 2017 who began non-targeted systemic therapy within 120 days of diagnosis.

During the study period, the overwhelming majority of veterans received chemotherapy (96%), while 3.4% received immunotherapy, and 0.6% received both. Patients who received both therapies were excluded from the analysis.

The immunotherapy patients were three years older than chemotherapy patients, a median of 69 years vs. 66 years. Immunotherapy was more likely to be offered to patients in the Midwest and West, while patients and in the Northeast and South were more likely to receive chemotherapy. Otherwise, the researchers noted no significant differences in demographics or clinical characteristics between the two groups of patients.

Patients who received immunotherapy lived longer, with an estimated median overall survival of 7.9 months compared to 7.5 months and an unadjusted reduction in risk of death of 29%.

When the team performed an analysis of propensity score matched patients at a 1:4 ratio of immunotherapy patients (144) to chemotherapy patients (559), the reduction in mortality risk was 25%.

Veterans receiving immunotherapy had more outpatient visits, 47 vs. 36, but there was no difference in the number or length of hospital stays.

Common adverse events among patients receiving immunotherapy included dyspnea (58%), colitis/enterocolitis (42%), and anemia (30%). Among those receiving chemotherapy, the most common adverse events were colitis/enterocolitis (36%), anemia (32%), and nausea or vomiting (31%).

The researchers recommended “continued assessment of treatment patterns and impact of [immunotherapy]” as its use continues to grow.

  1. Williams CD, Gu L, Vashistha V, Press A, Kelley MJ. “Comparison of characteristics and outcomes among veterans receiving first-line immunotherapy versus chemotherapy for stage IV non-small cell lung cancer.” Abstract 319295. 2020 ASCO Annual Meeting. May 29-31, 2020.