This study assessed real-world treatment patterns, healthcare resource utilization, and healthcare costs in the US adults with metastatic non-small cell lung cancer (NSCLC) receiving second or later line (2L+) treatment for non-actionable alterations.

Adults with metastatic NSCLC who received 2L+ treatment for non-actionable alterations from January 1, 2020, to March 31, 2023, were identified using the US Optum deidentified Clinformatics® database. Patients were continuously enrolled in health plans for ≥180 days before NSCLC diagnosis until ≥30 days after receiving treatment.

5310 patients met the inclusion criteria and received 2L+ treatments (7010). Median age was 73 years; 86% were insured by Medicare Advantage. Commonly used 2L+ treatments were mono or dual immunotherapy (IO) without chemotherapy (CT) (43.2%) and IO plus platinum-based CT (PBCT) (13.4%). Median treatment duration and time to next treatment were 3.8 months and 6.0 months respectively and were low for CT without IO. Healthcare resource utilization was mainly attributed to outpatient visits (mean: 5.09 per-patient per-month [PPPM]) and were highest for CT without IO. Patients receiving CT without IOs also had the highest rates of inpatient and emergency utilization. Mean total healthcare costs were $27,105 PPPM with hospitalization costs being highest for CT without IO.

In the treatment of 2L+ metastatic NSCLC, chemotherapy without IO was associated with poor treatment duration, high inpatient, emergency care utilization, and substantial economic burden. These results highlight the need for more efficacious, safe and cost-efficient treatment options in the 2L+ setting.