Lior Apter ¹ Sarah Sharman Moser ^2* Ashwini Arunachalam ³ Sivan Gazit ² Moshe Hoshen ² Gabriel Chodick ⁴ Nava Siegelmann-Danieli ¹

• ¹ Maccabi Health Care Services, Tel Aviv, Israel
• ² Kahan-Sagol-Maccabi Research and Innovation Institute, Tel-Aviv, Israel
• ³ Merck (United States), Kenilworth, New Jersey, United States
• ⁴ Tel Aviv University, Tel Aviv, Tel Aviv, Israel

Background: Treatment for first-line (1L) metastatic non-small cell cancer (mNSCLC) changed with the introduction of immunotherapy. We describe treatment utilization and clinical outcomes in a real-world mNSCLC cohort in a 2.7-million-member state-mandated health provider.Methods: Newly diagnosed mNSCLC patients initiating systemic anti-cancer treatment Jan 2017-Dec 2020 were identified from the National Cancer Registry. Real-world Time on Treatment (rwToT) was defined as the length of time between first and last administration date of treatment.Real-world Overall Survival (rwOS) was estimated using Kaplan Meier analysis. Outcomes were assessed at a minimum of 6 months' follow-up (cutoff: 30 th June 2021).Results: Among 843 patients, 85% had adenocarcinoma (NSQ) and 15% squamous cell carcinoma (SQ) histology: of these 43% and 26% were female, median age was 67 and 69 years, and 55% and 48% with 0-1 ECOG performance status respectively (missing:27% and 30% respectively). Median follow-up for the entire cohort was 27.1 months (95% CI: 24.7-29.6). NSQ patients with no known EGFR/ALK/ROS1 aberrations received PD-1 inhibitor monotherapy (PDM) (N=147), or combination (PDC) (N=194), or platinum-based chemotherapy (PBC, N=133). Median rwToT was 4.5 (95% CI: 3.5-7.6), 5.2 (95% CI: 4.6-7.6) and 2.3 (95% CI: 2.1-3.0) months respectively; for the subgroup of patients with ECOG PS 0-1, rwToT was 9.4 (95% CI: 5.0-20.8), 7.1 (95% CI: 5.0-10.1) and 2.9 (95% CI: 2.2-4.1) months respectively. Median rwOS from 1L was 12.5 (95% CI: 9.9-17.9), 14.8 (95% CI: 10.5-19.4) and 9.1 (95% CI: 7.1-11.5) months; for the subgroup of patients with ECOG PS 0-1, median rwOS was 25.1 (95% CI: 14.9-not reached [NR]), 17.6 (95% CI: 14.3-NR) and 11.3 (95% CI: 9.2-21.3) months respectively. For ECOG PS 0-1 and PDL1 >=50% patients, median rwOS was 25.1 months (95% CI: 13.9-NR) and NR for PDM and PDC respectively. For ECOG PS 0-1 and PDL1 <50% patients, median rwOS was 14.3 (95% CI: 10.1-NR) and 11.2 (95% CI: 9.1-21.3) months for PDC and PBC respectively.Our real-world data supports the benefit of single agent PD-1 inhibitor monotherapy for patients with PD-L1 high expression or PD-1 inhibitor combination for all patients diagnosed with mNSCLC with no known EGFR/ALK/ROS1 aberrations, initiating 1L treatment.