In a recent study entitled “Real-world treatment patterns and costs in a US Medicare population with metastatic squamous non-small cell lung cancer,” researchers summarize the current state of metastatic squamous non-small cell lung cancer (NSCLC) analyzing treatment patterns, healthcare use, and patients’ survival. The study was published in the journal Lung Cancer.

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for 85% to 90% of all lung cancers. In NSCLC, squamous cell carcinomas starts in squamous cells, the cells that line the interior of lung airways. Here, researchers identified and followed patients with metastatic squamous NSCLC for one year via the Surveillance, Epidemiology and End Results-Medicare database.

In total, they followed and analyzed 17,133 patients at least 65 years old. Cancer-directed therapy, either surgery, radiation, chemotherapy, or biologic therapy was received by 72% of all patients, while the remaining 28% received only supportive care. This difference in treatment resulted in a marked difference in patients’ median survival, with those under cancer-directed therapy surviving for an additional 8 months when compared to 2 months survival in patients receiving supportive care.

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Patients treated with chemotherapy (7,700 patients) received in its majority as first-line regimen first-line carboplatin-paclitaxel combination therapy (46%); second-line regimens included gemcitabine monotherapy (16%); and pemetrexed monotherapy (11%). While the first line treatment adopted was consistent with National Comprehensive Cancer Network (NCCN) guidelines, the team identified the second line treatments as varied and were not always consistent with NCCN guidelines (specialists recommend Docetaxel monotherapy as second-line management of advanced squamous NSCLC, while pemetrexed is recommended as second-line therapy for patients with non squamous advanced NSCLC).

The team also estimated the direct economic burden of metastatic squamous NSCLC in Medicare elderly beneficiaries. The authors point out that the US Medicare system spent approximately a total of 2 billion dollars in direct costs for metastatic squamous NSCLC in cases diagnosed in 2011 alone. At the population-level, the team estimates that metastatic squamous NSCLC is responsible for 14% to 40% Medicare expenditures on lung cancer annually.

In conclusion, authors highlight the study shows prognosis is still very poor for all patients with metastatic squamous NSCLC, particularly in those that are only on supportive care. As a result, while this patient population still suffers from unmet medical demands, second- and third-line therapies are often not in agreement with NCCN recommendations. Costs with metastatic squamous NSCLC are high and with increasing aging population the costs on Medicare system are estimated to continue rising.