A cross-sectional analysis of treatment patterns in small-cell lung cancer in five European countries

Figures & data

Table 1. Patient demographics and clinical characteristics.

Country	EU5	France	Germany	Italy	Spain	UK
N	5832	544	1518	1850	771	1149
Gender, n (%)
Female	1989 (34.1)	150 (27.6)	543 (35.8)	573 (31.0)	210 (27.2)	513 (44.6)
Male	3843 (65.9)	394 (72.4)	975 (64.2)	1277 (69.0)	561 (72.8)	636 (55.4)
Age at diagnosis (derived)
Mean (SD)	64.7 (8.6)	63.1 (8.3)	63.8 (8.3)	65.8 (8.7)	64.2 (8.3)	65 (9.2)
Median (Q1, Q3)	66 (58, 72)	63 (58, 68)	63 (58, 68)	67.7 (58, 72.8)	63 (58, 71.8)	67 (58, 72.4)
Min, Max	27.0, 83.5	27.0, 83.5	31.0, 83.5	33.0, 83.5	37.4, 83.5	32.0, 83.5
Smoking status not including 2021^†, n (%)
	n = 4425	n = 374	n = 1142	n = 1454	n = 594	n = 861
Yes	2316 (52.3)	234 (62.6)	649 (56.8)	670 (46.1)	303 (51.0)	460 (53.4)
No, but has smoked in the past	1684 (38.1)	113 (30.2)	405 (35.5)	613 (42.2)	226 (38.1)	327 (38.0)
No, and has not smoked in the past	364 (8.2)	23 (6.2)	78 (6.8)	133 (9.2)	65 (10.9)	65 (7.6)
Not known	61 (1.4)	4 (1.1)	10 (0.9)	38 (2.6)	0 (0.0)	9 (1.1)
Disease stage at primary diagnosis, n (%)
≤ II	50 (0.9)	11 (2.0)	14 (0.9)	10 (0.5)	8 (1.0)	7 (0.6)
III	304 (5.2)	30 (5.5)	66 (4.4)	78 (4.2)	53 (6.9)	77 (6.7)
IV	5158 (88.4)	503 (92.5)	1438 (94.7)	1443 (78.0)	709 (92.0)	1065 (92.7)
Unknown	320 (5.5)	0 (0.0)	0 (0.0)	319 (17.2)	1 (0.1)	0 (0.0)
ECOG performance status^‡, n (%)
0	651 (11.2)	32 (5.9)	94 (6.2)	429 (23.2)	38 (4.9)	58 (5.0)
1	3,699 (63.4)	362 (66.5)	960 (63.2)	1138 (61.5)	534 (69.3)	705 (61.4)
2	1336 (22.9)	135 (24.8)	432 (28.5)	237 (12.8)	189 (24.5)	343 (29.9)
3	112 (1.9)	15 (2.8)	30 (2.0)	16 (0.9)	10 (1.3)	41 (3.6)
4	4 (0.1)	0 (0.0)	2 (0.1)	0 (0.0)	0 (0.0)	2 (0.2)
N/A	30 (0.5)	0 (0.0)	0 (0.0)	30 (1.6)	0 (0.0)	0 (0.0)
Site of treatment, n (%)
Academic hospital	2041 (35.0)	214 (39.3)	156 (10.3)	439 (23.7)	575 (74.6)	657 (57.2)
Specialist cancer facility	2419 (41.5)	236 (43.4)	503 (33.1)	1090 (58.9)	196 (25.4)	394 (34.3)
General hospital	519 (8.9)	94 (17.3)	10 (0.7)	317 (17.1)	0 (0.0)	98 (8.5)
Office-based practitioner	849 (14.6)	0 (0.0)	849 (55.9)	0 (0.0)	0 (0.0)	0 (0.0)
Unknown	4 (0.1)	0 (0.0)	0 (0.0)	4 (0.2)	0 (0.0)	0 (0.0)

ECOG: Eastern Cooperative Oncology Group; EU5: France, Germany, Italy, Spain and the UK; N/A: Not available; Q1: Quartile 1; Q3: Quartile 3; SD: Standard deviation.

† Smoking status from 2018 to 2020; data on smoking status were not collected in 2021.

‡ ECOG performance status scale interpretation: 0-asymptomatic; 1-symptomatic fully ambulatory; 2-symptomatic in bed less than 50% of the day; 3-symptomatic in bed greater than 50% of the day but not bedridden; 4-bedridden.

Figure 1. First-line treatment regimens for extensive-stage small cell lung cancer in EU5*.

*Regimens that contributed <2% individually to total percentage from 2018 to 2021 are not shown.

EU5: France, Germany, Italy, Spain and the UK; IO mono/combo: Immunotherapy monotherapy or combination, including ipilimumab/nivolumab combination regimen; Pt: Platinum; Pt + atezolizumab: Platinum-based chemotherapy with atezolizumab combination regimen; Pt + durvalumab: Platinum-based chemotherapy with durvalumab combination regimen; Pt + etoposide: Platinum-based chemotherapy with etoposide combination regimen.

Figure 2. Change in the proportion of patients treated with chemoimmunotherapy between 2018 and 2021 in EU5.

Change in proportions of patients treated with (A) platinum-based chemotherapy-atezolizumab combination and (B) platinum-based chemotherapy and durvalumab combination as first-line treatment for ES-SCLC between 2018 and 2021 in EU5 (overall) and in individual EU5 countries.

ES-SCLC: Extensive-stage small-cell lung cancer; EU5: France, Germany, Italy, Spain and the UK.

Figure 3. Second-line treatment regimens for extensive-stage small cell lung cancer in EU5 between 2018 and 2021*.

*Regimens that contributed <2% individually to total percentage from 2018 to 2021 are not shown. Consequently, percentages do not add up to 100% in each analyzed year.

Cyc/Dox/Vinc: Cyclophosphamide, doxorubicin and vincristine combination chemotherapy.

Figure 4. Second-line treatment patterns according to sensitivity to platinum chemotherapy*.

Second-line treatment regimens used for patients with (A) platinum-sensitive and (B) platinum-resistant ES-SCLC between 2018 and 2021 in EU5.

*Regimens that collectively contributed <2% to total percentage from 2018 to 2021 are not shown. Consequently, percentages may not add up to 100%.

Carb: Carboplatin; Cyc/Dox/Vinc: Cyclophosphamide/doxorubicin/vincristine; Etop: Etoposide; ES-SCLC: Extensive-stage small-cell lung cancer; EU5: France, Germany, Italy, Spain and the UK.

Table 2. Treatment regimens for small-cell lung cancer in the third line and beyond.

Current regimen, n (%)	Third-line treatments				Fourth-line and subsequent treatments
	2018	2019	2020	2021	2018	2019	2020	2021
	n = 23	n = 26	n = 26	n = 23	n = 7	n = 8	n = 9	n = 8
Non–platinum-based chemotherapy (excluding etoposide)^†	10 (43.5)	14 (53.9)	13 (50.0)	13 (56.5)	2 (28.6)	3 (37.5)	3 (33.3)	4 (50.0)
Other chemotherapy combination^‡	8 (34.8)	2 (7.7)	3 (11.5)	5 (21.7)	2 (28.6)	2 (25.0)	1 (11.1)	0 (0.0)
Platinum-based chemotherapy + etoposide	2 (8.7)	1 (3.9)	2 (7.7)	0 (0.0)	1 (14.3)	0 (0.0)	2 (22.2)	3 (37.5)
Other non-chemotherapy^§	2 (8.7)	5 (19.2)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
Platinum-based chemotherapy + other	1 (4.4)	3 (11.5)	2 (7.7)	2 (8.7)	2 (28.6)	0 (0.0)	2 (22.2)	0 (0.0)
Immunotherapy monotherapy or combination, including ipilimumab + nivolumab	0 (0.0)	1 (3.9)	6 (23.1)	3 (13.0)	0 (0.0)	3 (37.5)	1 (11.1)	0 (0.0)
Etoposide monotherapy	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	1 (12.5)

† Non–platinum-based chemotherapies included irinotecan with fluorouracil, docetaxel, gemcitabine, irinotecan, lurbinectedin, paclitaxel, pemetrexed and topotecan.

‡ Other chemotherapy combinations included cyclophosphamide/doxorubicin, cyclophosphamide/doxorubicin/ vincristine, cyclophosphamide/epirubicin, cyclophosphamide/epirubicin/vincristine, bevacizumab/topotecan, bevacizumab/paclitaxel, docetaxel/nintedanib. gemcitabine/irinotecan, gemcitabine/paclitaxel and irinotecan/paclitaxel.

§ Other non-chemotherapy options included bevacizumab, erlotinib, osimertinib, rovalpituzumab tesirine and tinostamustine.