BEPACT lung: A prospective, multicenter, non-interventional study of decision factors in the first-line treatment of metastatic non-small cell lung cancer (NSCLC)

Background: Rapidly evolving treatment options for advanced NSCLC can lead to difficulties in implementing those changes in daily practice. Insight into real-world treatment choices might help identify needs for better patient care. Methods: 215 consecutive metastatic treatment-naïve NSCLC patients were prospectively enrolled in BEPACT Lung (NCT03959137) between June-Oct 2019 in 21 Belgian hospitals. Data collected: treatment site (high vs low volume (HV vs LV)); patients’ characteristics (demographics, medical history, comorbidities, autoimmune disease, medications, prior treatment for earlier stage NSCLC); tumor characteristics; patients’ preference; treatment type (chemotherapy (C), immunotherapy (I), immuno-chemotherapy (I+C), best supportive care (BSC)). The primary objective was to identify factors influencing the treatment choice using first a simple logistic regression model, and then entering factors with p < 0.25 in a multiple logistic regression model. Results: HV and LV centers showed similar patients’ characteristics. Median age 68.2 years, 65.1% male, 77% performance status (PS) ≤1, 95.7% (former)smokers, 65.6% non-squamous, 42.1% Programmed Death-Ligand1 (PD-L1) high (≥50%). In the PD-L1 high group, simple logistic regression pointed at age (p = .0167), prior treatment (p = .0544), tumor size (p = .0643), number of comorbidities (p = 0.1679) and weight loss (p = .2146) as factors in the choice of I alone vs I+C; in the multiple regression model, this was age (p = .0642), weight loss (p = .0458) and prior treatment (p = .0582). In the PD-L1 low group, simple logistic regression pointed at PS (p < 0.0001), weight loss (p = .0440), patients’ preference (p = .0636), age (p = .1149), antibiotics (p = .1366) and smoking status (p = 0.1566) for the choice of I+C vs C alone or BSC; in multivariate analysis, this was PS (p = .0005), age (p = .0308), and patients’ preference (p = .0585). Conclusions: In PD-L1 high tumors, the choice of I alone (vs I+C) was more likely with higher age, more weight loss, and no prior treatment. In PD-L1 low tumors, the choice of I+C (vs C alone/BSC) was more likely in case of good PS, younger age or patients’ preference. Clinical trial identification: NCT03959137 Study Start date: June 1, 2019 Study Completion date: October 31, 2019.