An observational study to identify selection criteria for initiation of different first line treatment options in patients with non-small cell lung cancer

BACKGROUND: Lung cancer remains a leading cause of cancer-related mortality. Despite advancements in diagnostics and treatment, clinical decision-making often incorporates factors not captured in clinical trials or registries. This study aimed to identify key parameters influencing treatment choices for untreated stage IV non-small cell lung cancer (NSCLC) patients using real-world data from Sweden. METHODS: A multicenter study between April 2021 and April 2023 involving 359 patients from five Swedish hospitals was conducted to explore factors influencing treatment decisions for untreated stage IV NSCLC. A standardized data collection tool, developed for this study was used to gather key clinical and demographic variables-such as performance status, age, comorbidities, histology, molecular profiling, and selected treatment, as well as how the treatment decision was made-based on information extracted from electronic medical records. RESULTS: Chemotherapy combined with immunotherapy was the most common treatment (39%), followed by best supportive care (20%) and chemotherapy alone (14%). Performance status and age were the most frequently cited factors influencing treatment decisions. Multidisciplinary team decisions guided most of the cases, and approximately two-thirds of treatments (66%) were influenced by national guidelines, based on physician reports. CONCLUSION: The study underscores the dynamic nature of NSCLC and the importance of a multifaceted approach to treatment decisions involving patient-specific factors, multidisciplinary team input, and adherence to guidelines.