Second line chemotherapy exposure in a German Cancer Society certified lung cancer center: single center experience of 3 years and relevance for maintenance therapy

Introduction: One of the strongest rationale for maintenance therapy in NSCLC is the fact that exposure to 2nd line therapy is only 40 – 60% in clinical trials in specialized treatment centers. Even with follow-up intervals of 6 weeks, the 2nd line treatment rate does not seem to increase in clinical trials. One of the main arguments for maintenance treatment is that 2nd line exposure in international clinical trials does not reflect the situation of treatment management in Germany. Therefore, we analyzed the exposure of patients with stage IV NSCLC in one German Cancer Society certified Lung Cancer Center since certification, as long term follow-up data are available. Methods. All primary lung cancer cases stage IV in the lung cancer center were analyzed based on the documentation files between 2009 and 2013. Patients were followed between 1st and 2nd line therapy every 6 – 8 weeks according to S3 guidelines. Results: 203 patients were diagnosed with NSCLC IV (UICC7), or had systemic relapse of localized disease and were treated with 1st line therapy for metastatic disease. 32 (16%) of all patients received maintenance therapy, most of them with bevacizumab. Of 203 patients, 176 progressed after 1st line therapy or 1st line and maintenance therapy. 117/176 (66%) pts. received 2nd line therapy. 59 pts (34%) did not. Reasons for not receiving 2nd line therapy were mostly associated with intercurrent bone metastases that needed surgery and or radiotherapy and CNS metastases requiring radiation, as well as non-cancer related causes. Of 24 pts receiving maintenance therapy and requiring 2nd line therapy, 20 (83%) received 2nd line therapy. Survival analyses will be presented at the meeting. Conclusion: In a certified lung cancer center and stringent follow-up every 6 to 8 weeks, 1/3 of patients does not receive 2nd line therapy. The application of maintenance therapy raised the chances of receiving 2nd line therapy. Multiple metastases, especially bone and CNS, requiring radiation therapy, were associated with not receiving 2nd line therapy. These data suggest that maintenance therapy should be more widely adopted and that radiation therapy for bone and CNS metastases should if possible be accompanied by systemic treatment.