{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T19:02:11Z","timestamp":1770490931716,"version":"3.49.0"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T00:00:00Z","timestamp":1599696000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T00:00:00Z","timestamp":1599696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Bristol-Myers Squibb Company","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pulm Med"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>As part of the multinational I-O Optimise research initiative, this retrospective cohort study of patients with advanced non-small cell lung cancer (NSCLC) evaluated real-world treatment patterns and survival prior to immunotherapy reimbursement in Portugal.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This study utilized a database held by IPO-Porto, Portugal\u2019s largest oncology hospital. Adult patients diagnosed with stage IIIB or IV NSCLC from January 2012 to December 2016 at IPO-Porto, with follow-up to June 2017, were included. Treatment analyses were performed from 2015 onwards. Kaplan\u2013Meier methods were used for overall survival (OS). Factors associated with OS and systemic anti-cancer therapy (SACT) treatment were assessed using multivariate statistical models.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 1524 patients diagnosed with NSCLC at IPO-Porto, 1008 patients had advanced disease (stage IIIB: 10.1%, 154\/1524, stage IV: 56.0%, 854\/1524). For those with advanced disease, median age was 65\u2009years (range: 21\u201392) and 75.6% (762\/1008) were male. Median OS (interquartile range [IQR]) was 11.4 (5.2\u201326.9) months for stage IIIB and 6.3 (2.4\u201315.0) months for stage IV. Factors associated with decreased risk of death included female sex and epidermal growth factor receptor gene (<jats:italic>EGFR<\/jats:italic>)\/anaplastic lymphoma kinase gene (<jats:italic>ALK<\/jats:italic>) mutations\/rearrangements; factors associated with increased risk of death included older age and stage IV disease. Among patients diagnosed in 2015 or 2016, 75.8% (297\/392) received \u22651 line of SACT. Platinum-based chemotherapy was the most common first-line therapy (non-squamous cell carcinoma [NSQ]: 72.9%; squamous cell carcinoma [SQ] 87.3%, 55\/63; patients with <jats:italic>EGFR<\/jats:italic>\/<jats:italic>ALK<\/jats:italic> mutations\/rearrangements primarily received tyrosine kinase inhibitors). The likelihood of receiving SACT was lower in older patients and those diagnosed with stage IV disease. Patients not receiving SACT had poor survival outcomes (median OS [IQR]: NSQ, 1.8 [1.1\u20133.1] months; SQ, 2.3 (1.3\u20133.4) months), while median OS (IQR) in SACT-treated patients was 12.6 (6.1\u201324.5) months for NSQ and 10.3 (5.7\u201315.9) months for SQ.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This real-world data analysis from a large Portuguese oncology hospital demonstrates a high disease burden for advanced NSCLC in the pre-immunotherapy era, with nearly one-quarter of patients not receiving SACT. Even in patients receiving SACT, median survival was only about 1\u2009year.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12890-020-01270-z","type":"journal-article","created":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T18:03:52Z","timestamp":1599761032000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Real-world treatment patterns and survival outcomes for advanced non-small cell lung cancer in the pre-immunotherapy era in Portugal: a retrospective analysis from the I-O Optimise initiative"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6071-3673","authenticated-orcid":false,"given":"Marta","family":"Soares","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3098-0711","authenticated-orcid":false,"given":"Lu\u00eds","family":"Antunes","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8560-1646","authenticated-orcid":false,"given":"Patr\u00edcia","family":"Redondo","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8073-6506","authenticated-orcid":false,"given":"Marina","family":"Borges","sequence":"additional","affiliation":[]},{"given":"Ruben","family":"Hermans","sequence":"additional","affiliation":[]},{"given":"Dony","family":"Patel","sequence":"additional","affiliation":[]},{"given":"Fiona","family":"Grimson","sequence":"additional","affiliation":[]},{"given":"Robin","family":"Munro","sequence":"additional","affiliation":[]},{"given":"Carlos","family":"Chaib","sequence":"additional","affiliation":[]},{"given":"Laure","family":"Lacoin","sequence":"additional","affiliation":[]},{"given":"Melinda","family":"Daumont","sequence":"additional","affiliation":[]},{"given":"John R.","family":"Penrod","sequence":"additional","affiliation":[]},{"given":"John C.","family":"O\u2019Donnell","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7690-9830","authenticated-orcid":false,"given":"Maria Jos\u00e9","family":"Bento","sequence":"additional","affiliation":[]},{"given":"Francisco","family":"Rocha Gon\u00e7alves","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2020,9,10]]},"reference":[{"issue":"6","key":"1270_CR1","doi-asserted-by":"crossref","first-page":"394","DOI":"10.3322\/caac.21492","volume":"68","author":"F Bray","year":"2018","unstructured":"Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394\u2013424.","journal-title":"CA Cancer J Clin"},{"key":"1270_CR2","unstructured":"GLOBOCAN. Global Cancer Observatory. [Internet]. 2018. Available from: https:\/\/gco.iarc.fr\/. Accessed 13 Aug 2019."},{"key":"1270_CR3","first-page":"765","volume":"11","author":"JM Lopes","year":"2017","unstructured":"Lopes JM, Goncalves FR, Borges M, Redondo P, Laranja-Pontes J. The cost of cancer treatment in Portugal. Ecancermedicalscience. 2017;11:765.","journal-title":"Ecancermedicalscience."},{"issue":"7","key":"1270_CR4","doi-asserted-by":"publisher","first-page":"A626","DOI":"10.1016\/j.jval.2014.08.2228","volume":"17","author":"M Borges","year":"2014","unstructured":"Borges M, Gouveia M, Alarcao J, Sousa R, Teixeira E, Barata F, et al. Cost and burden of non-small cell lung cancer's in Portugal. Value Health. 2014;17(7):A626.","journal-title":"Value Health"},{"issue":"Supplement_4","key":"1270_CR5","doi-asserted-by":"publisher","first-page":"iv192","DOI":"10.1093\/annonc\/mdy275","volume":"29","author":"D Planchard","year":"2018","unstructured":"Planchard D, Popat S, Kerr K, Novello S, Smit EF, Faivre-Finn C, et al. Metastatic non-small cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Supplement_4):iv192\u2013237.","journal-title":"Ann Oncol"},{"key":"1270_CR6","doi-asserted-by":"publisher","first-page":"63","DOI":"10.2147\/ITT.S125070","volume":"7","author":"S Raju","year":"2018","unstructured":"Raju S, Joseph R, Sehgal S. Review of checkpoint immunotherapy for the management of non-small cell lung cancer. Immunotargets Ther. 2018;7:63\u201375.","journal-title":"Immunotargets Ther"},{"issue":"8","key":"1270_CR7","first-page":"2234","volume":"10","author":"H Qin","year":"2018","unstructured":"Qin H, Wang F, Liu H, Zeng Z, Wang S, Pan X, et al. New advances in immunotherapy for non-small cell lung cancer. Am J Transl Res. 2018;10(8):2234\u201345.","journal-title":"Am J Transl Res"},{"issue":"17","key":"1270_CR8","doi-asserted-by":"publisher","first-page":"1627","DOI":"10.1056\/NEJMoa1507643","volume":"373","author":"H Borghaei","year":"2015","unstructured":"Borghaei H, Paz-Ares L, Horn L, Spigel DR, Steins M, Ready NE, et al. Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med. 2015;373(17):1627\u201339.","journal-title":"N Engl J Med"},{"issue":"2","key":"1270_CR9","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1056\/NEJMoa1504627","volume":"373","author":"J Brahmer","year":"2015","unstructured":"Brahmer J, Reckamp KL, Baas P, Crino L, Eberhardt WE, Poddubskaya E, et al. Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med. 2015;373(2):123\u201335.","journal-title":"N Engl J Med"},{"issue":"19","key":"1270_CR10","doi-asserted-by":"publisher","first-page":"1823","DOI":"10.1056\/NEJMoa1606774","volume":"375","author":"M Reck","year":"2016","unstructured":"Reck M, Rodriguez-Abreu D, Robinson AG, Hui R, Csoszi T, Fulop A, et al. Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med. 2016;375(19):1823\u201333.","journal-title":"N Engl J Med"},{"issue":"10066","key":"1270_CR11","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/S0140-6736(16)32517-X","volume":"389","author":"A Rittmeyer","year":"2017","unstructured":"Rittmeyer A, Barlesi F, Waterkamp D, Park K, Ciardiello F, von Pawel J, et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet. 2017;389(10066):255\u201365.","journal-title":"Lancet."},{"issue":"4","key":"1270_CR12","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1016\/S1470-2045(18)30144-X","volume":"19","author":"MC Garassino","year":"2018","unstructured":"Garassino MC, Cho BC, Kim JH, Mazieres J, Vansteenkiste J, Lena H, et al. Durvalumab as third-line or later treatment for advanced non-small-cell lung cancer (ATLANTIC): an open-label, single-arm, phase 2 study. Lancet Oncol. 2018;19(4):521\u201336.","journal-title":"Lancet Oncol."},{"key":"1270_CR13","doi-asserted-by":"crossref","unstructured":"Ekman S, Griesinger F, Baas P, Chao D, Chouaid C, O'Donnell JC, et al. I-O Optimise: a novel multinational real-world research platform in thoracic malignancies. Future Oncol. 2019;15(14):1551\u201363.","DOI":"10.2217\/fon-2019-0025"},{"issue":"1","key":"1270_CR14","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1378\/chest.08-0978","volume":"136","author":"FC Detterbeck","year":"2009","unstructured":"Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest. 2009;136(1):260\u201371.","journal-title":"Chest."},{"issue":"1","key":"1270_CR15","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.rppneu.2012.08.002","volume":"19","author":"AS Castro","year":"2013","unstructured":"Castro AS, Parente B, Goncalves I, Antunes A, Barroso A, Conde S, et al. Epidermal growth factor receptor mutation study for 5 years, in a population of patients with non-small cell lung cancer. Rev Port Pneumol. 2013;19(1):7\u201312.","journal-title":"Rev Port Pneumol"},{"issue":"1","key":"1270_CR16","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.arbres.2017.07.012","volume":"54","author":"F Aguiar","year":"2018","unstructured":"Aguiar F, Fernandes G, Queiroga H, Machado JC, Cirnes L, Souto Moura C, et al. Overall survival analysis and characterization of an EGFR mutated non-small cell lung cancer (NSCLC) population. Arch Bronconeumol. 2018;54(1):10\u20137.","journal-title":"Arch Bronconeumol"},{"key":"1270_CR17","doi-asserted-by":"crossref","unstructured":"de Castro J, Tagliaferri P, de Lima VCC, Ng S, Thomas M, Arunachalam A, et al. Systemic therapy treatment patterns in patients with advanced non-small cell lung cancer (NSCLC): PIvOTAL study. Eur J Cancer Care. 2017;26(6):e12734.","DOI":"10.1111\/ecc.12734"},{"issue":"9","key":"1270_CR18","doi-asserted-by":"publisher","first-page":"1370","DOI":"10.1097\/JTO.0000000000000621","volume":"10","author":"R Ramlau","year":"2015","unstructured":"Ramlau R, Cufer T, Berzinec P, Dziadziuszko R, Olszewski W, Popper H, et al. Epidermal growth factor receptor mutation-positive non-small-cell lung cancer in the real-world setting in Central Europe: the INSIGHT study. J Thorac Oncol. 2015;10(9):1370\u20134.","journal-title":"J Thorac Oncol"},{"key":"1270_CR19","doi-asserted-by":"crossref","unstructured":"Verleye L, De Gendt C, Vrijens F, Schillemans V, Camberlin C, Silversmit G, et al. Patterns of care for non-small cell lung cancer patients in Belgium: a population-based study. Eur J Cancer Care. 2018;27(1):e12747.","DOI":"10.1111\/ecc.12747"},{"key":"1270_CR20","doi-asserted-by":"publisher","unstructured":"Ekman S, S\u00f8rensen JB, Brustugun OT, Horvat D, Patel D, Rosenlund M, et al. Treatment (Tx) patterns and overall survival (OS) in patients (pts) with NSCLC in Sweden: a SCAN-LEAF study analysis from the I-O Optimise initiative. Ann Oncol. 2019;30(Supplement_2):ii17. Abstract 47P.\u00a0https:\/\/doi.org\/10.1093\/annonc\/mdz070.005.","DOI":"10.1093\/annonc\/mdz070.005"},{"key":"1270_CR21","doi-asserted-by":"publisher","unstructured":"S\u00f8rensen JB, Ekman S, Brustugun OT, Horvat D, Patel D, Rosenlund M, et al. Evolution of overall survival (OS) in patients (pts) with incident NSCLC in Denmark and Sweden: a SCAN-LEAF study analysis from the I-O Optimise initiative. Ann Oncol. 2019;30(Supplement_2):ii16\u2013ii17. Abstract 46P. https:\/\/doi.org\/10.1093\/annonc\/mdz070.004.","DOI":"10.1093\/annonc\/mdz070.004"},{"issue":"9","key":"1270_CR22","doi-asserted-by":"publisher","first-page":"5468","DOI":"10.21037\/jtd.2018.08.49","volume":"10","author":"A Caballero Vazquez","year":"2018","unstructured":"Caballero Vazquez A, Garcia Flores P, Romero Ortiz A, Del Moral RG, Alcazar-Navarrete B. Changes in non-small cell lung cancer diagnosis, molecular testing and prognosis 2011-2016. J Thorac Dis. 2018;10(9):5468\u201375.","journal-title":"J Thorac Dis"},{"key":"1270_CR23","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/j.lungcan.2017.07.031","volume":"112","author":"U von Verschuer","year":"2017","unstructured":"von Verschuer U, Schnell R, Tessen HW, Eggert J, Binninger A, Spring L, et al. Treatment, outcome and quality of life of 1239 patients with advanced non-small cell lung cancer - final results from the prospective German TLK cohort study. Lung Cancer. 2017;112:216\u201324.","journal-title":"Lung Cancer"},{"key":"1270_CR24","doi-asserted-by":"crossref","unstructured":"Ess SM, Herrmann C, Frick H, Krapf M, Cerny T, Jochum W, et al. Epidermal growth factor receptor and anaplastic lymphoma kinase testing and mutation prevalence in patients with advanced non-small cell lung cancer in Switzerland: a comprehensive evaluation of real world practices. Eur J Cancer Care. 2017;26(6):e12721.","DOI":"10.1111\/ecc.12721"},{"issue":"6","key":"1270_CR25","doi-asserted-by":"publisher","first-page":"3735","DOI":"10.21873\/anticanres.12654","volume":"38","author":"KN Syrigos","year":"2018","unstructured":"Syrigos KN, Georgoulias V, Zarogoulidis K, Makrantonakis P, Charpidou A, Christodoulou C. Epidemiological characteristics, EGFR status and management patterns of advanced non-small cell lung cancer patients: the Greek REASON observational registry study. Anticancer Res. 2018;38(6):3735\u201344.","journal-title":"Anticancer Res"},{"issue":"8","key":"1270_CR26","doi-asserted-by":"publisher","first-page":"1254","DOI":"10.1158\/1055-9965.EPI-14-1149","volume":"24","author":"W Schuette","year":"2015","unstructured":"Schuette W, Schirmacher P, Eberhardt WE, Fischer JR, von der Schulenburg JM, Mezger J, et al. EGFR mutation status and first-line treatment in patients with stage III\/IV non-small cell lung cancer in Germany: an observational study. Cancer Epidem Biomar. 2015;24(8):1254\u201361.","journal-title":"Cancer Epidem Biomar"},{"issue":"5","key":"1270_CR27","first-page":"5611","volume":"14","author":"R Ramlau","year":"2017","unstructured":"Ramlau R, Krawczyk P, Dziadziuszko R, Chmielewska I, Milanowski J, Olszewski W, et al. Predictors of EGFR mutation and factors associated with clinical tumor stage at diagnosis: experience of the INSIGHT study in Poland. Oncol Lett. 2017;14(5):5611\u20138.","journal-title":"Oncol Lett"},{"issue":"1","key":"1270_CR28","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/s12885-018-4032-3","volume":"18","author":"W Schuette","year":"2018","unstructured":"Schuette W, Schirmacher P, Eberhardt WEE, Dietel M, Zirrgiebel U, Muehlenhoff L, et al. Treatment decisions, clinical outcomes, and pharmacoeconomics in the treatment of patients with EGFR mutated stage III\/IV NSCLC in Germany: an observational study. BMC Cancer. 2018;18(1):135.","journal-title":"BMC Cancer"},{"issue":"5","key":"1270_CR29","doi-asserted-by":"publisher","first-page":"E387","DOI":"10.1002\/ijc.29216","volume":"136","author":"MJ Aarts","year":"2015","unstructured":"Aarts MJ, van den Borne BE, Biesma B, Kloover JS, Aerts JG, Lemmens VE. Improvement in population-based survival of stage IV NSCLC due to increased use of chemotherapy. Int J Cancer. 2015;136(5):E387\u201395.","journal-title":"Int J Cancer"},{"key":"1270_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.canep.2017.08.001","volume":"51","author":"BJM Peters","year":"2017","unstructured":"Peters BJM, Cramer-Vd Welle CM, Smit AAJ, Schramel F, van de Garde EMW. Trends in prescribing systemic treatment and overall survival for non-small cell lung cancer stage IIIB\/IV in the Netherlands: 2008-2012. Cancer Epidemiol. 2017;51:1\u20136.","journal-title":"Cancer Epidemiol"},{"key":"1270_CR31","unstructured":"S\u00f8rensen JB, Ekman S, Brustugun OT, Horvat P, Patel D, Rosenlund M, et al. Evolution of overall survival in patients with incident NSCLC in Denmark and Sweden: a SCAN-LEAF study analysis from the I-O Optimise initiative. Presented at: 9th European Lung Cancer Congress; 10\u201313 April 2019; Geneva, Switzerland. 2019. Poster number: 46P."},{"issue":"10, Supplement","key":"1270_CR32","doi-asserted-by":"publisher","first-page":"S700","DOI":"10.1016\/j.jtho.2018.08.1145","volume":"13","author":"M Snee","year":"2018","unstructured":"Snee M, Cheeseman S, Thompson M, Lacoin L, Sopwith W, Chaib C, et al. P2.01\u201391 Treatment patterns in patients with stage IIIB-IV NSCLC in clinical practice: retrospective analysis of a UK trust database. J Thorac Oncol. 2018;13(10, Supplement):S700.","journal-title":"J Thorac Oncol"},{"issue":"4","key":"1270_CR33","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1093\/annonc\/mdi126","volume":"16","author":"JL Pujol","year":"2005","unstructured":"Pujol JL, Breton JL, Gervais R, Rebattu P, Depierre A, Morere JF, et al. Gemcitabine-docetaxel versus cisplatin-vinorelbine in advanced or metastatic non-small-cell lung cancer: a phase III study addressing the case for cisplatin. Ann Oncol. 2005;16(4):602\u201310.","journal-title":"Ann Oncol"},{"issue":"3","key":"1270_CR34","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/j.lungcan.2006.05.023","volume":"53","author":"LE Raez","year":"2006","unstructured":"Raez LE, Santos ES, Lopes G, Rosado MF, Negret LM, Rocha-Lima C, et al. Efficacy and safety of oxaliplatin and docetaxel in patients with locally advanced and metastatic non-small-cell lung cancer (NSCLC). Lung Cancer. 2006;53(3):347\u201353.","journal-title":"Lung Cancer"},{"issue":"10","key":"1270_CR35","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1056\/NEJMoa0810699","volume":"361","author":"TS Mok","year":"2009","unstructured":"Mok TS, Wu YL, Thongprasert S, Yang CH, Chu DT, Saijo N, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med. 2009;361(10):947\u201357.","journal-title":"N Engl J Med"},{"issue":"3","key":"1270_CR36","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1016\/S1470-2045(11)70393-X","volume":"13","author":"R Rosell","year":"2012","unstructured":"Rosell R, Carcereny E, Gervais R, Vergnenegre A, Massuti B, Felip E, et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2012;13(3):239\u201346.","journal-title":"Lancet Oncol."},{"issue":"27","key":"1270_CR37","doi-asserted-by":"publisher","first-page":"3327","DOI":"10.1200\/JCO.2012.44.2806","volume":"31","author":"LV Sequist","year":"2013","unstructured":"Sequist LV, Yang JC, Yamamoto N, O'Byrne K, Hirsh V, Mok T, et al. Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol. 2013;31(27):3327\u201334.","journal-title":"J Clin Oncol"},{"issue":"8","key":"1270_CR38","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/S1470-2045(11)70184-X","volume":"12","author":"C Zhou","year":"2011","unstructured":"Zhou C, Wu YL, Chen G, Feng J, Liu XQ, Wang C, et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label, randomised, phase 3 study. Lancet Oncol. 2011;12(8):735\u201342.","journal-title":"Lancet Oncol."},{"issue":"2","key":"1270_CR39","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/S1470-2045(13)70604-1","volume":"15","author":"YL Wu","year":"2014","unstructured":"Wu YL, Zhou C, Hu CP, Feng J, Lu S, Huang Y, et al. Afatinib versus cisplatin plus gemcitabine for first-line treatment of Asian patients with advanced non-small-cell lung cancer harbouring EGFR mutations (LUX-lung 6): an open-label, randomised phase 3 trial. Lancet Oncol. 2014;15(2):213\u201322.","journal-title":"Lancet Oncol"},{"issue":"7","key":"1270_CR40","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1056\/NEJMoa1612674","volume":"376","author":"TS Mok","year":"2017","unstructured":"Mok TS, Wu YL, Ahn MJ, Garassino MC, Kim HR, Ramalingam SS, et al. Osimertinib or platinum-pemetrexed in EGFR T790M-positive lung cancer. N Engl J Med. 2017;376(7):629\u201340.","journal-title":"N Engl J Med"},{"issue":"2","key":"1270_CR41","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.lungcan.2015.02.011","volume":"88","author":"D Moro-Sibilot","year":"2015","unstructured":"Moro-Sibilot D, Smit E, de Castro CJ, Lesniewski-Kmak K, Aerts J, Villatoro R, et al. Outcomes and resource use of non-small cell lung cancer (NSCLC) patients treated with first-line platinum-based chemotherapy across Europe: FRAME prospective observational study. Lung Cancer. 2015;88(2):215\u201322.","journal-title":"Lung Cancer"}],"container-title":["BMC Pulmonary Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-020-01270-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12890-020-01270-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-020-01270-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T23:11:56Z","timestamp":1631229116000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpulmmed.biomedcentral.com\/articles\/10.1186\/s12890-020-01270-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,10]]},"references-count":41,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1270"],"URL":"https:\/\/doi.org\/10.1186\/s12890-020-01270-z","relation":{},"ISSN":["1471-2466"],"issn-type":[{"value":"1471-2466","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,10]]},"assertion":[{"value":"30 April 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 August 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 September 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was conducted in accordance with the International Society for Pharmacoepidemiology (ISPE) Guidelines for Good Epidemiology Practices and the ethical principles that have their origin in the Declaration of Helsinki. The laws and regulatory requirements in Portugal were followed. The protocol received approval by the Institutional Review Board (IRB; Ethics Committee of the Portuguese Oncology Institute of Porto). This was a retrospective observational study using anonymised patient data. Patients were not contacted or directly impacted by study participation in any way, thus obtaining informed consent was not applicable.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"MS, LA, PR, MB, and MJB are employees of IPO-Porto.MB received personal fees and non-financial support from Roche and non-financial support from Janssen outside the submitted work.FRG has no competing interests.RH, DP, FG, and RM are employees of IQVIA.CC, MD, JRP, and JCO are employees of Bristol\u00a0Myers Squibb.CC and JRP report stock ownership in Bristol\u00a0Myers Squibb.LL was contracted (paid) as consultant by Bristol\u00a0Myers Squibb to support the I-O Optimise initiative and is an employee of Epi-Fit.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"240"}}