We have robust and clinically rich oncology data in all major regions of the world. We've highlighted a portion of non-small cell lung cancer (NSCLC) data in Japan, Germany, China, Brazil and the United States from two of our best-in-class databases: National Health and Wellness Survey (NHWS) and CancerMPact®. Click on the tabs below to reveal data and our synopses.
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Across all geographies, non-small cell lung cancer (NSCLC) is seen more commonly in males. Patients in Japan have the highest mean age, and are the least likely to be employed full-time.
Globally, Stage I/II patients are more likely to undergo surgery alone or in combination with adjuvant chemotherapy. Stage IIIA disease is managed more aggressively, with greater use of radiotherapy or adjuvant chemotherapy. The use of surgical resection is less in patients with Stage IIIA disease compared to earlier stages, although patients in Germany and China are more likely to receive surgery than patients in the U.S., Japan, or Brazil. In the U.S. and Brazil, chemoradiotherapy is the preferred standard of care for Stage IIIA disease.
Platinum-doublets are the standard of care as first-line therapy for advanced or metastatic NSCLC, although the choice of doublet may vary globally. In patients with squamous histology, platinum-taxane is most commonly used in the U.S., whereas platinum-gemcitabine is preferred in other countries. In patients with non-squamous histology, the availabiltiy and improved efficacy of Alimta and Avastin (which aren't approved for squamous disease) established a different standard of care. In the U.S., Avastin-based and Alimta-based regimens are almost equally utilized. In Germany, Avastin-based regimens are more likely utilized, whereas in Japan and Brazil there is a greater preference for Alimta-based regimens. In China, treatment is more commonly based on generic chemotherapies such as platinums or taxanes. In the second-line setting, taxane monotherapy is the most commonly used treatment globally and regardless of histology, although Alimta monotherapy is also highly used in the U.S. and Germany in non-squamous NSCLC. Treatment of NSCLC is also segmented by biomarker status, with targeted therapies approved in many countries for the treatment of paitents with EGFR or ALK mutations. The EGFR inhibitor Tarceva is the preferred treatment for EGFR mutant patients in the U.s. and Brazil, while the inhibitor Iressa is favored in Germany, Japan, and China, largely due to different market launch orders globally. In patients with ALK mutation, Xalkori is the only approved agent, and while it is the most commonly used agent in these patients in the markets in which it is approved, overall use varies; greatest adoption has occurred in the U.S., while market share is lower in Germany and Japan. The same EGFR or ALK inhibitors are most commonly used in second-line for mutant patients, although this typically reflects patients who did not receive the targeted agent in first-line. For patients who received an EGFR or ALK inhibitor in first-line, second-line therapy is similar to the first-line options in that country for non-squamous NSCLC patients.
Treatment of NSCLC is segmented by histology and by biomarker status, with targeted therapies approved in many countries for the treatment of paitents with EGFR or ALK mutations. In order to identify patients with these mutations who are eligible for treatment with these targeted therapies, NSCLC patients must be tested with a companion diagnostic assay. Testing for EGFR mutations in the first-line setting is highest in the U.S., Japan, and Brazil, used in two-thirds to three-quarters of patients. EGFR testing is slightly less in Germany and China (approximately one half of patients). Diagnostic testing for ALK mutations is less common than testing for EGFR mutations in all regions, although it is highest in the U.S. The lower use of ALK testing is in-part due to a common practice of sequencing these diagnostic assays, wherein patients found to be be EGFR mutants will not be further tested for an ALK mutation. Only one-quarter to one-third of patients are tested for ALK mutation in Germany and Japan, compared to more than half of patients in the U.S.; this lower testing rate likely reflects less time on the market for the assay and the targeted ALK inhibitor, as well as (in the case of Germany) approval of the ALK targeted therapy that is limited to second-line; this may reduce testing practices in first-line. These two mutations are rare. EGFR mutation rates vary by ethnicity, with a greater incidence in Asian patients than in Caucasian patients; there is no established variation in ALK mutation rates by ethnicity - it occurs in approximately 5% of NSCLC patients globally.