Immunotherapy for every fifth lung cancer patient

As more types of immunotherapy have been approved for use among lung cancer patients, the Cancer Registry's new overview shows that there is now a significant proportion of patients who receive such treatment, either alone or in combination with other treatments, such as radiation or chemotherapy.

"Of patients diagnosed with lung cancer in 2019, 1 in 5 patients received treatment that included immunotherapy," says Lena Holmström, project manager for the INSPIRE project.

INSPIRE is a large and unique collaboration between public, private and voluntary actors, where the goal has been to establish a system for obtaining information from the professional systems in hospitals about the use of cancer drugs.

For the largest subgroup of lung cancer, namely non-small cell lung cancer, there have been major breakthroughs in the immunotherapy field. Here, as many as 1 in 3 now receive some form of new and advanced drug treatment.

Such treatment is usually dependent on the patient having a gene expression indicating that treatment with immunotherapy may be appropriate. For other subtypes of lung cancer, the possibilities for treatment with immunotherapy are still more limited.

"For small cell lung cancer, chemotherapy still dominates drug treatment," says Holmström.

Quadrupling in five years

The collection of information on drug cancer treatment is still in an early phase, and so far only the regions Western Norway and Central Norway Regional Health Authority Norway have had systems where it is possible to retrieve data far back in time.

Thus, it is also only possible to look at trends over time for these regions.

The results show that in the Western Norway Regional Health Authority and in the Norway Central Norway Regional Health Authority, the use of immunotherapy has increased from 6 per cent in 2015 to 25 per cent in 2019, i.e. there is more than a fourfold increase in the proportion of patients who have received this option over the course of five years.

The Cancer Registry of Norway has also looked at other features in the development of pharmacological cancer treatment in the two regions.

"Among other things, we see that the proportion who receive drug cancer treatment is the same for women and men. The proportion receiving this type of treatment is highest in the age group 50-69 years. Somewhat lower among those in their 70s, and among those over 80, drug cancer treatment is less common," says Lena Holmström.

The Cancer Registry of Norway still lacks data on lung cancer patients in the Northern Norway Regional Health Authority, but since most lung cancer patients belong to other health regions, the coverage rate is still 89 per cent. 

Provides a more complete picture

With information about drug cancer treatment, the Cancer Registry of Norway can now show a more complete picture of the treatment lung cancer patients receive after diagnosis.

"So far, we have had a good overview of two of the three important forms of treatment for cancer, namely surgery and radiation. Now we finally also get long-awaited and very useful knowledge about how treatment with drugs is distributed, says Director of the Cancer Registry, Giske Ursin.

The new overview has, for example, made it possible for the Cancer Registry of Norway to prepare analyses that show the first treatment distributed by the stage of the cancer. Thus, it is not only information about drug cancer treatment in itself that the Cancer Registry now has, but also a far more complete picture of the entire patient group's treatment. Thus, it is also possible to look at the entire course of treatment over time.

For example, this is the picture of the first treatment for non-small cell lung cancer, for patients diagnosed in 2019: (click to enlarge)

It is mainly for patients in advanced stages that the initial treatment is characterised by drugs, i.e. immunotherapy or chemotherapy, often in combination with radiation therapy.

More than 10 per cent of patients died before they could receive treatment for their cancer. The vast majority of these were diagnosed with advanced stage cancer.

Some of the findings about treatment are known from earlier, such as that surgery is most relevant for those who detect the cancer early, while other information is completely new, such as the scope and distribution of drug treatment.

Still too early for conclusions on efficacy

An important objective of the overview of drug cancer treatment is not only the use itself, but also the effect on the patients.

However, it is still too early to look at the results, both because the follow-up time in the data collected so far is too short, and because the Cancer Registry of Norway and researchers need more time to perform the analyses that form the basis for results on survival and mortality.

"These will be important elements in the upcoming follow-up, and in the future it is natural for such analyses to be included in the annual reports from the Quality Registries," says Holmström.

What is already known is that survival for patients with lung cancer has improved greatly in recent years – and five-year relative survival is now three times higher than at the beginning of the 1990s (see Annual report 2019, National Quality Registry for Lung Cancer).

Even for patients with distant metastasis, survival has jumped slightly in recent years, even though this group is still among the cancer patients with the worst prognosis.

"Just how much of the improvement comes as a result of drug treatment, and how much has to do with more precise surgery and radiation, are some of the things we are now looking forward to investigating further. Hopefully, the statistics can also guide us so that even more patients with lung cancer in the future can live even longer and better with their disease, says Director Giske Ursin.

About INSPIRE

INSPIRE is uniquely a collaborative project between the public, private and voluntary sectors, and for the first time it is possible to present high-quality data on drug cancer treatment.

Actors included in the project are the Cancer Registry, Inven2, the pharmaceutical industry, the Norwegian Cancer Society and the health regions.

The purpose is to collect data on drug cancer treatment in Norway, as this has been an inadequate part of the Cancer Registry's data sources.

The project can now present the first results from the pilot project covering lung cancer. This type of cancer was chosen because it is a serious disease, a large part of the treatment is drug cancer treatment and in recent years there has been an increased focus on the treatment of lung cancer. The supply of drugs targeting biomarkers has also increased in recent years.

After lung cancer as a pilot form of cancer, information and analyses for the other cancers will soon follow, first of all breast cancer.

The Cancer Registry of Norway has data with high completeness for surgery and radiotherapy, but information for medical cancer treatment has been inadequate.

With more data, the INSPIRE project will make it possible to provide a complete picture of the patient's course of treatment and cancer treatment in Norway.

A significant part of the project involves harvesting data from the hospitals' professional systems (CMS, Cytodose) and transferring them to the Cancer Registry. In addition, the project has explored how the Cancer Registry of Norway can use the Norwegian Patient Registry (NPR) as a data source for cancer drugs patients take at home (H-prescription).