The treatment landscape for patients with metastatic non-small cell lung cancer (mNSCLC) is rapidly evolving as new therapies are continually introduced. This study aimed to provide a contemporary overview of how patients diagnosed with mNSCLC in the Netherlands are treated in routine clinical practice, how applied systemic treatments are tolerated and with which overall survival (OS).

This nationwide retrospective study utilised data from the Netherlands Cancer Registry (NCR) complemented by electronic health records data of patients diagnosed with stage IV non-oncogenic mNSCLC in the years 2019–2020. First-line (1 L) treatments and corresponding overall survival (OS) were identified and compared across hospital types (academic, teaching, general), along with a multivariable analysis of 1 L treatment, patient, and tumour characteristics. In a subset of seven teaching hospitals, dose adjustments, early discontinuations and follow-up treatments were also assessed together with ESMO guideline adherence based on ECOG scores and levels of PD-L1 tumour expression.

The total sample comprised 9511 patients (56 % male and mean age 68 years) of which 4485 (47 %) received best supportive care (BSC) only. The most frequently applied 1 L systemic treatment was chemo-immunotherapy with 51 % one-year survival. Starting any 1 L systemic treatment was more frequent among patients with younger age, better performance status, PD-L1 > 50 %, and those with their diagnosis established in an academic hospital. Chemotherapy was discontinued early (<4 cycles) in 46 % of patients with 1 L chemotherapy and 34 % of patients with chemo-immunotherapy. Guideline adherence was highest in patients with ECOG1 and PD-L1 1–49 % (76 %) and lowest in the ECOG > = 2 and PD-L1 1–49 % group (30 %).

Best supportive care over systemic treatment and chemotherapy treatment modifications are common in patients with mNSCLC. Presenting information to patients about these outcomes can support shared-decision making.