Lung Cancer: Patient Registry Study

1 . INTRODUCTION

2. EXECUTIVE SUMMARY

3 . KEY INSIGHTS

4 . SEGMENTS

Agenda

•

•

•

•

•

•

The ALCF lung cancer patient registry survey covers most aspects of the lung cancer treatment

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

Respondent Profile

1 . INTRODUCTION

2. EXECUTIVE SUMMARY

3 . KEY INSIGHTS

4 . SEGMENTS

Agenda

Executive Summary – Symptoms and Diagnosis

On an average, patients experience ~2 symptoms before diagnosis;

shortness of breath, fatigue and pain are other common symptoms

A significantly higher proportion of non-smokers and younger patients experience symptoms; however, they are treated more for diseases

other than lung cancer initially and thus are often diagnosed at late stages

S

S

S

S

S

S

S

S

S

S

S

• There is a need to educate non-smokers, younger patients and also PCPs about the different symptoms of lung

cancer to help increase the rate of early diagnosis, and consequently, reduce the extent of incorrect treatment

• Patients suspected to have pneumonia should be encouraged for lung cancer screening, given similar symptoms;

screening would reduce the time spent in treating for diseases other than lung cancer

Three-fifths of the patients who visited a PCP were treated for

diseases other than lung cancer leading to delay in diagnosis

S

Executive Summary – Testing and Treatment

Biopsy is a well established diagnostic test followed

closely by PET/CT regardless of patient

characteristics

Mutation testing is more common among patients diagnosed at late stages; NGS

is gaining preference though lung cancer specific mutation panel continues to be

significantly preferred – method used does not differ by patient profile

Surgery is most preferred at early stages, while at the

later stages patients are treated with targeted therapy

Targeted therapy is most preferred almost across all mutation

types; immunotherapy is preferred for PDL-1 and KRAS patients

• Mutation testing on patient’s biopsy at an early stage would help make better treatment decisions which are

dependent on the disease stage and mutation type

• Use of next generation sequencing - quick / cost-effective methodology compared to testing for limited number of

genes at a time - could be promoted more

1 . INTRODUCTION

2. EXECUTIVE SUMMARY

3 . KEY INSIGHTS

4 . SEGMENTS

Agenda

Takeaways

Cough (50%), shortness of Breath (32%), fatigue (27%) and pain (25%) are the most common symptoms before being

diagnosed with lung cancer

More than half of the patients visit a Primary Care Physician regarding symptoms

Key Insights – Symptoms

SS

S

Key Insights – Testing

Takeaways

Biopsy, PET/CT, and CT are the most commonly performed diagnostic tests

On average, patients undergo about 4 diagnostic tests

Bronchoscopy, fine needle aspiration, and surgery are the most common types of biopsies done

S

S

Takeaways

Three-fourths of the patients have had a molecular / biomarker / genetic testing

Lung cancer specific mutation panel is significantly more likely to be performed compared to Next generation sequencing

Key Insights – Testing

S

S

Among the patients who tested positive for molecular/biomarker/genetic testing, ALK was the most widely identified

mutation type, followed by EGFR and PDL-1

Key Insights – Testing

Takeaways

Takeaways

Almost three-fifths of the patients received initial treatment for something other than lung cancer; the most common disease

these patients received initial treatment for is Pneumonia

Key Insights – Diagnosis

S

S

Takeaways

Among the patients who are currently receiving treatment, almost half are receiving targeted therapy

Targeted therapy is the most preferred choice of treatment across lines, followed by chemotherapy and immunotherapy with

almost equal patient share

Key Insights – Current Treatment

SS

S

S

S

S

Takeaways

At the earliest stage of lung cancer- stage I - when the cancer is operable, patients undergo surgery, while at the later

stages - stages 2,3 and 4 - patients are treated with targeted therapy or chemotherapy or immunotherapy

Key Insights – Current Treatment

S

S

S

S

Chemotherapy is the most common treatment among patients who’ve received prior treatment, followed by radiation

therapy and surgery

Chemotherapy is a preferred prior treatment option to a significantly higher proportion of patients who are currently in the

2L+ line of therapy, followed by radiation and targeted therapy

Takeaways

Key Insights – Prior Treatment

S

S

S

S

S

1 . INTRODUCTION

2. EXECUTIVE SUMMARY

3 . KEY INSIGHTS

4 . SEGMENTS

Agenda

Segments – Based on Time Taken to Diagnose

Takeaways

Symptoms before the diagnosis of lung cancer and patients receiving initial treatment for diseases other than lung cancer is

more prevalent in patients who were diagnosed later than 3 months

Patients who initially see an ‘Emergency room physician’ or ‘Urgent care’ are significantly likely to be diagnosed in <= 3

months than others

S

S

S

S

S

S

S

S

S

S

Segments – Based on Stage of Diagnosis

Takeaways

Patients diagnosed at later stages experienced more symptoms and are more prone to driver mutations

ALK rearrangements are more common in later stages while mutations like EGFR and KRAS were associated with patients

diagnosed at earlier stages

S

S

S

S

S

S

S

S

S

S

S

S

Segments – Based on Stage of Diagnosis

Takeaways

Brain MRI was used significantly more in patients diagnosed at later stages, as the chances of brain metastases are higher

in these patients

Surgery was the most preferred treatment for patients diagnosed at early stages (since it is operable), while targeted

therapy was used significantly for patients diagnosed at later stages

S

S

S

S

S

S

S

S

Segments – Based on Mutation

Takeaways

Current treatment for PDL1 +ve is focused on immunotherapy options and other mutation types are treated predominantly

with targeted therapies

Segments – Based on Patient’s Smoking History

S

S

S

S

S

S

S

Takeaways

Non-smokers considered cough, fatigue, and pain as more serious symptoms than smokers

Lung cancer in non-smokers was diagnosed significantly more at later stages, being first attributed to a respiratory infection

or even allergies or any other disease

S

S

S

S

S

S

S

Segments – Based on Patient’s Smoking History

S

S

S

S

S

S

Takeaways

Lung cancer led brain metastases is more common in non-smokers and hence brain MRI diagnostic test was taken more

significantly among non-smokers

Targeted therapy is more frequently used in non-smokers, primarily driven by stage of diagnosis (85% in later stages) and

mutation type (47% with ALK mutation)

S

S

S

S

Segments – Based on Age

Takeaways

A higher proportion of young patients with symptoms were treated for diseases other than lung cancer leading to delayed

diagnosis

Targeted therapy is the preferred treatment option in young patients

S

S

S

S

S

S

S

S

S

S

Segments – Time of Survival