Q (haiku): What are the most frequently administered systemic therapy regimens for lung cancer patients in the MSK-CHORD Study?

▶ read_guide
{
 "uri": "cbioportal://treatment-guide"
}

▶ resolve_and_route
{
 "studyIds": [
  "msk_chord_2024"
 ]
}

◀ result
# Treatment Data Query Guide

## Overview

Treatment data in cBioPortal is stored in **clinical event tables**, separate from clinical attributes. This allows for timeline-based treatment records with start/stop dates.

## Start Here: Treatment Views

For "most common treatments / agents / regimens in study X", use the parameterized views (documented in `cbioportal://clinical-data-guide`, Study-View Chart Counts):

```sql
-- Patients per agent (the portal's Treatment chart), with type/subtype arrays
SELECT * FROM treatment_counts_in_study(study='msk_chord_2024') ORDER BY patients DESC LIMIT 20;

-- Same-day agent combinations (investigational, prior-medication and radiation events excluded)
SELECT * FROM treatment_regimens_in_study(study='msk_chord_2024') ORDER BY patients DESC LIMIT 20;
```

Write raw event queries (below) only for subgroups, timelines or keys the views do not expose.

## Key Tables

| Table | Description |
|-------|-------------|
| `clinical_event` | Event records with patient_id, event_type, start_date, stop_date |
| `clinical_event_data` | Key-value pairs linked to each clinical_event_id |

## Schema

```
clinical_event
├── clinical_event_id (PK)
├── patient_id (FK → patient.internal_id)
├── event_type (Treatment, TREATMENT, Diagnosis, SURGERY, etc.)
├── start_date (days from diagnosis)
└── stop_date (days from diagnosis)

clinical_event_data
├── clinical_event_id (FK)
├── key (AGENT, SUBTYPE, etc.)
└── value
```

## Event Types

Not all studies have all event types. Common ones include:

| Event Type | Description |
|------------|-------------|
| `Treatment` / `TREATMENT` | Drug/therapy administration |
| `SURGERY` | Surgical procedures |
| `Diagnosis` | Diagnosis events |
| `LAB_TEST` | Laboratory results |
| `Sequencing` | Sequencing events |
| `Sample acquisition` | Sample collection |
| `PATHOLOGY` / `Pathology` | Pathology reports |

## Basic Treatment Queries

### List Available Event Types in a Study

```sql
SELECT DISTINCT ce.event_type, COUNT(*) as event_count
FROM clinical_event ce
JOIN patient p ON ce.patient_id = p.internal_id
JOIN cancer_study cs ON p.cancer_study_id = cs.cancer_study_id
WHERE cs.cancer_study_identifier = 'your_study_id'
GROUP BY ce.event_type
ORDER BY event_count DESC;
```

### List Treatment Data Keys in a Study

```sql
SELECT DISTINCT ced.key, COUNT(*) as cnt
FROM clinical_event ce
JOIN clinical_event_data ced ON ce.clinical_event_id = ced.clinical_event_id
JOIN patient p ON ce.patient_id = p.internal_id
JOIN cancer_study cs ON p.cancer_study_id = cs.cancer_study_id
WHERE cs.cancer_study_identifier = 'your_study_id'
  AND ce.event_type IN ('Treatment', 'TREATMENT')
GROUP BY ced.key
ORDER BY cnt DESC;
```

### Get Most Common Treatment Agents

```sql
SELECT 
    ced.value as agent,
    COUNT(DISTINCT ce.patient_id) as patient_count
FROM clinical_event ce
JOIN clinical_event_data ced ON ce.clinical_event_id = ced.clinical_event_id
JOIN patient p ON ce.patient_id = p.internal_id
JOIN cancer_stud … (6220 more chars)

◀ result
{"success":true,"message":"Found 1 study. Use the metadata to call the appropriate navigation tool(s).","data":{"totalCount":1,"studiesWithMetadata":[{"studyId":"msk_chord_2024","name":"MSK-CHORD (MSK, Nature 2024)","sampleCount":25040,"studyViewUrl":"https://www.cbioportal.org/study?id=msk_chord_2024","metadata":{"clinicalAttributeIds":["ADRENAL_GLANDS","BONE","CANCER_TYPE","CANCER_TYPE_DETAILED","CLINICAL_GROUP","CLINICAL_SUMMARY","CNS_BRAIN","CURRENT_AGE_DEID","DIAGNOSIS_DESCRIPTION","ETHNICITY","FRACTION_GENOME_ALTERED","GENDER","GENE_PANEL","GLEASON_FIRST_REPORTED","GLEASON_HIGHEST_REPORTED","GLEASON_SAMPLE_LEVEL","HER2","HISTORY_OF_PDL1","HR","ICD_O_HISTOLOGY_DESCRIPTION","INTRA_ABDOMINAL","LIVER","LUNG","LYMPH_NODES","METASTATIC_SITE","MSI_COMMENT","MSI_SCORE","MSI_TYPE","MUTATION_COUNT","NUM_ICDO_DX","ONCOTREE_CODE","OS_MONTHS","OS_STATUS","OTHER","PATHOLOGICAL_GROUP","PDL1_POSITIVE","PLEURA","PRIMARY_SITE","PRIOR_MED_TO_MSK","RACE","REPRODUCTIVE_ORGANS","SAMPLE_CLASS","SAMPLE_COUNT","SAMPLE_COVERAGE","SAMPLE_TYPE","SMOKING_PREDICTIONS_3_CLASSES","SOMATIC_STATUS","STAGE_HIGHEST_RECORDED","TMB_NONSYNONYMOUS","TUMOR_PURITY"],"molecularProfileIds":["msk_chord_2024_cna","msk_chord_2024_mutations","msk_chord_2024_structural_variants"],"availableComparisonTabs":["overlap","clinical","survival","alterations","mutations"]}}]}}

▶ clickhouse_run_select_query
{
 "query": "
-- First, let's get an overview of treatment event types available in MSK-CHORD
SELECT DISTINCT ce.event_type, COUNT(*) as event_count
FROM clinical_event ce
JOIN patient p ON ce.patient_id = p.internal_id
JOIN cancer_study cs ON p.cancer_study_id = cs.cancer_study_id
WHERE cs.cancer_study_identifier = 'msk_chord_2024'
GROUP BY ce.event_type
ORDER BY event_count DESC
",
 "max_rows": 100
}

◀ result
{"rows":[{"event_type":"Diagnosis","event_count":1486868},{"event_type":"Lab_Test","event_count":480739},{"event_type":"Treatment","event_count":183652},{"event_type":"Surgery","event_count":76301},{"event_type":"Sequencing","event_count":25040},{"event_type":"Sample acquisition","event_count":25040},{"event_type":"Pathology","event_count":16731}]}

▶ clickhouse_run_select_query
{
 "query": "
-- Get treatment regimens for lung cancer patients in MSK-CHORD
-- First identify lung cancer patients and their treatment regimens
WITH lung_cancer_patients AS (
  SELECT DISTINCT p.internal_id, p.patient_id
  FROM patient p
  JOIN cancer_study cs ON p.cancer_study_id = cs.cancer_study_id
  JOIN clinical_data_derived cdd ON p.internal_id = cdd.patient_id 
    AND cdd.cancer_study_identifier = cs.cancer_study_identifier
  WHERE cs.cancer_study_identifier = 'msk_chord_2024'
    AND cdd.attribute_name = 'CANCER_TYPE'
    AND (cdd.attribute_value LIKE '%Lung%' OR cdd.attribute_value = 'Non-Small Cell Lung Cancer' OR cdd.attribute_value = 'Small Cell Lung Cancer')
)
-- Get treatment regimens (same-day agent combinations)
SELECT 
    lcp.patient_id,
    CASE 
        WHEN agent.value IS NOT NULL AND subtype.value IS NOT NULL 
        THEN CONCAT(agent.value, ' (', subtype.value, ')')
        WHEN agent.value IS NOT NULL THEN agent.value
        ELSE 'Unknown'
    END as regimen,
    ce.start_date,
    COUNT(*) OVER (PARTITION BY agent.value, subtype.value) as regimen_frequency
FROM clinical_event ce
JOIN lung_cancer_patients lcp ON ce.patient_id = lcp.internal_id
LEFT JOIN clinical_event_data agent ON ce.clinical_event_id = agent.clinical_event_id AND agent.key = 'AGENT'
LEFT JOIN clinical_event_data subtype ON ce.clinical_event_id = subtype.clinical_event_id AND subtype.key = 'SUBTYPE'
WHERE ce.event_type = 'Treatment'
LIMIT 1000
",
 "max_rows": 100
}

◀ result
{"error_message":"Query execution failed: HTTPDriver for https://dl96orhu96.us-east-1.aws.clickhouse.cloud:8443 received ClickHouse error code 47\n Code: 47. DB::Exception: Identifier 'cdd.patient_id' cannot be resolved from table with name cdd. In scope  lung_cancer_patients AS lcp. (UNKNOWN_IDENTIFIER) (version 26.4.1.2359 (official build))\n"}

▶ clickhouse_list_table_columns
{
 "table": "clinical_data_derived"
}

◀ result
{"columns":[{"name":"internal_id","type":"Int32"},{"name":"sample_unique_id","type":"String","comment":"Globally unique sample ID: cancer_study_identifier + \"_\" + sample.stable_id. Empty for patient-level attributes. Use this for sample filtering and joins."},{"name":"patient_unique_id","type":"String","comment":"Globally unique patient ID: cancer_study_identifier + \"_\" + patient.stable_id. Present for both sample and patient-level attributes."},{"name":"attribute_name","type":"LowCardinality(String)","comment":"Clinical attribute name (e.g., SAMPLE_TYPE, CANCER_TYPE, AGE, OS_MONTHS). Use with attribute_value for filtering. AGE may be floored or capped for de-identification (e.g. all children recorded as 18, or everyone 89+ recorded as 89 or 90): before age statistics check for a pile-up at the min/max, and if present compute age from DAYS_TO_BIRTH (-days / 365.25)."},{"name":"attribute_value","type":"String","comment":"Value of the clinical attribute (String). For SAMPLE_TYPE: Primary, Metastasis, Local Recurrence, Unknown. Missing values are empty strings, so use toFloat64OrNull(attribute_value) for numeric comparisons — CAST fails on them."},{"name":"cancer_study_identifier","type":"LowCardinality(String)"},{"name":"type","type":"LowCardinality(String)","comment":"Data level: \"sample\" for sample-level attributes (e.g., SAMPLE_TYPE), \"patient\" for patient-level attributes (e.g., AGE, OS_MONTHS)."}]}

▶ clickhouse_run_select_query
{
 "query": "
-- Get treatment regimens for lung cancer patients in MSK-CHORD
-- First identify lung cancer patients
WITH lung_cancer_patients AS (
  SELECT DISTINCT patient_unique_id
  FROM clinical_data_derived
  WHERE cancer_study_identifier = 'msk_chord_2024'
    AND attribute_name = 'CANCER_TYPE'
    AND (attribute_value LIKE '%Lung%' OR attribute_value = 'Non-Small Cell Lung Cancer' OR attribute_value = 'Small Cell Lung Cancer')
)
-- Get treatment agents and subtypes for lung cancer patients
SELECT 
    agent.value as agent,
    subtype.value as treatment_subtype,
    COUNT(DISTINCT ce.patient_id) as patient_count,
    COUNT(*) as event_count
FROM clinical_event ce
JOIN patient p ON ce.patient_id = p.internal_id
JOIN cancer_study cs ON p.cancer_study_id = cs.cancer_study_id
JOIN lung_cancer_patients lcp ON CONCAT(cs.cancer_study_identifier, '_', p.stable_id) = lcp.patient_unique_id
LEFT JOIN clinical_event_data agent ON ce.clinical_event_id = agent.clinical_event_id AND agent.key = 'AGENT'
LEFT JOIN clinical_event_data subtype ON ce.clinical_event_id = subtype.clinical_event_id AND subtype.key = 'SUBTYPE'
WHERE cs.cancer_study_identifier = 'msk_chord_2024'
  AND ce.event_type = 'Treatment'
GROUP BY agent.value, subtype.value
ORDER BY patient_count DESC
LIMIT 30
",
 "max_rows": 100
}

◀ result
{"rows":[{"treatment_subtype":"Prior Medications to MSK","patient_count":6652,"event_count":6652},{"treatment_subtype":"Radiation Therapy","patient_count":4179,"event_count":10345},{"agent":"CARBOPLATIN","treatment_subtype":"Chemo","patient_count":3371,"event_count":3724},{"agent":"PEMETREXED","treatment_subtype":"Chemo","patient_count":3347,"event_count":3768},{"agent":"PEMBROLIZUMAB","treatment_subtype":"Immuno","patient_count":1569,"event_count":1729},{"agent":"INVESTIGATIONAL","treatment_subtype":"Investigational","patient_count":1479,"event_count":2576},{"agent":"CISPLATIN","treatment_subtype":"Chemo","patient_count":1228,"event_count":1263},{"agent":"GEMCITABINE","treatment_subtype":"Chemo","patient_count":1110,"event_count":1160},{"agent":"OSIMERTINIB","treatment_subtype":"Targeted","patient_count":1074,"event_count":1345},{"agent":"BEVACIZUMAB","treatment_subtype":"Biologic","patient_count":1036,"event_count":1203},{"agent":"DOCETAXEL","treatment_subtype":"Chemo","patient_count":830,"event_count":858},{"agent":"PACLITAXEL","treatment_subtype":"Chemo","patient_count":785,"event_count":817},{"agent":"NIVOLUMAB","treatment_subtype":"Immuno","patient_count":697,"event_count":756},{"agent":"ZOLEDRONIC ACID","treatment_subtype":"Bone Treatment","patient_count":588,"event_count":1181},{"agent":"MEGESTROL","treatment_subtype":"Hormone","patient_count":499,"event_count":557},{"agent":"ERLOTINIB","treatment_subtype":"Targeted","patient_count":489,"event_count":808},{"agent":"VINORELBINE","treatment_subtype":"Chemo","patient_count":476,"event_count":486},{"agent":"RAMUCIRUMAB","treatment_subtype":"Biologic","patient_count":432,"event_count":441},{"agent":"ETOPOSIDE","treatment_subtype":"Chemo","patient_count":319,"event_count":364},{"agent":"PACLITAXEL PROTEIN-BOUND","treatment_subtype":"Chemo","patient_count":319,"event_count":337},{"agent":"ATEZOLIZUMAB","treatment_subtype":"Immuno","patient_count":282,"event_count":297},{"agent":"CRIZOTINIB","treatment_subtype":"Targeted","patient_count":276,"event_count":349},{"agent":"DURVALUMAB","treatment_subtype":"Immuno","patient_count":240,"event_count":248},{"agent":"ALECTINIB","treatment_subtype":"Targeted","patient_count":198,"event_count":226},{"agent":"AFATINIB","treatment_subtype":"Targeted","patient_count":194,"event_count":216},{"agent":"IPILIMUMAB","treatment_subtype":"Immuno","patient_count":154,"event_count":164},{"agent":"CYCLOPHOSPHAMIDE","treatment_subtype":"Chemo","patient_count":146,"event_count":155},{"agent":"ANASTROZOLE","treatment_subtype":"Hormone","patient_count":136,"event_count":248},{"agent":"METHOTREXATE","treatment_subtype":"Chemo","patient_count":135,"event_count":159},{"agent":"FLUOROURACIL","treatment_subtype":"Chemo","patient_count":122,"event_count":139}]}

▶ clickhouse_run_select_query
{
 "query": "
-- Get same-day treatment agent combinations (regimens) for lung cancer patients
WITH lung_cancer_patients AS (
  SELECT DISTINCT patient_unique_id
  FROM clinical_data_derived
  WHERE cancer_study_identifier = 'msk_chord_2024'
    AND attribute_name = 'CANCER_TYPE'
    AND (attribute_value LIKE '%Lung%' OR attribute_value = 'Non-Small Cell Lung Cancer' OR attribute_value = 'Small Cell Lung Cancer')
),
lung_cancer_events AS (
  SELECT ce.clinical_event_id, ce.patient_id, ce.start_date
  FROM clinical_event ce
  JOIN patient p ON ce.patient_id = p.internal_id
  JOIN cancer_study cs ON p.cancer_study_id = cs.cancer_study_id
  JOIN lung_cancer_patients lcp ON CONCAT(cs.cancer_study_identifier, '_', p.stable_id) = lcp.patient_unique_id
  WHERE cs.cancer_study_identifier = 'msk_chord_2024'
    AND ce.event_type = 'Treatment'
),
agents_per_event AS (
  SELECT 
    lce.clinical_event_id,
    lce.patient_id,
    lce.start_date,
    ced.value as agent
  FROM lung_cancer_events lce
  LEFT JOIN clinical_event_data ced ON lce.clinical_event_id = ced.clinical_event_id AND ced.key = 'AGENT'
  WHERE ced.value IS NOT NULL
    AND ced.value NOT IN ('INVESTIGATIONAL', '')
)
-- Group agents on same day into regimens
SELECT 
    arrayStringConcat(arraySort(groupArray(DISTINCT agent)), ' + ') as regimen,
    COUNT(DISTINCT patient_id) as patient_count,
    COUNT(*) as event_count
FROM agents_per_event
GROUP BY patient_id, start_date
GROUP BY regimen
ORDER BY patient_count DESC
LIMIT 50
",
 "max_rows": 100
}

◀ result
{"error_message":"Query execution failed: HTTPDriver for https://dl96orhu96.us-east-1.aws.clickhouse.cloud:8443 received ClickHouse error code 62\n Code: 62. DB::Exception: Syntax error: failed at position 1452 (GROUP) (line 36, col 1): GROUP BY regimen\nORDER BY patient_count DESC\nLIMIT 50) LIMIT 101\n FORMAT Native. Expected one of: token sequence, Dot, token, OR, AND, IS NOT DISTINCT FROM, IS DISTINCT FROM, IS NULL, IS NOT NULL, BETWEEN, NOT BETWEEN, LIKE, ILIKE, NOT LIKE, NOT ILIKE, REGEXP, IN, NOT IN, GLOBAL IN, GLOBAL NOT IN, MOD, DIV, alias, AS, Comma, WITH, HAVING, WINDOW, QUALIFY, ORDER BY, LIMIT, OFFSET, FETCH, SETTINGS, UNION, EXCEPT, INTERSECT. (SYNTAX_ERROR) (version 26.4.1.2359 (official build))\n"}

▶ clickhouse_run_select_query
{
 "query": "
-- Get same-day treatment agent combinations (regimens) for lung cancer patients
WITH lung_cancer_patients AS (
  SELECT DISTINCT patient_unique_id
  FROM clinical_data_derived
  WHERE cancer_study_identifier = 'msk_chord_2024'
    AND attribute_name = 'CANCER_TYPE'
    AND (attribute_value LIKE '%Lung%' OR attribute_value = 'Non-Small Cell Lung Cancer' OR attribute_value = 'Small Cell Lung Cancer')
),
lung_cancer_events AS (
  SELECT ce.clinical_event_id, ce.patient_id, ce.start_date
  FROM clinical_event ce
  JOIN patient p ON ce.patient_id = p.internal_id
  JOIN cancer_study cs ON p.cancer_study_id = cs.cancer_study_id
  JOIN lung_cancer_patients lcp ON CONCAT(cs.cancer_study_identifier, '_', p.stable_id) = lcp.patient_unique_id
  WHERE cs.cancer_study_identifier = 'msk_chord_2024'
    AND ce.event_type = 'Treatment'
),
agents_per_event AS (
  SELECT 
    lce.patient_id,
    lce.start_date,
    ced.value as agent
  FROM lung_cancer_events lce
  LEFT JOIN clinical_event_data ced ON lce.clinical_event_id = ced.clinical_event_id AND ced.key = 'AGENT'
  WHERE ced.value IS NOT NULL
    AND ced.value NOT IN ('INVESTIGATIONAL', '')
),
regimens AS (
  SELECT 
    patient_id,
    start_date,
    arrayStringConcat(arraySort(groupArray(DISTINCT agent)), ' + ') as regimen
  FROM agents_per_event
  GROUP BY patient_id, start_date
)
SELECT 
    regimen,
    COUNT(DISTINCT patient_id) as patient_count,
    COUNT(*) as event_count
FROM regimens
GROUP BY regimen
ORDER BY patient_count DESC
LIMIT 50
",
 "max_rows": 100
}

◀ result
{"rows":[{"regimen":"CARBOPLATIN + PEMETREXED","patient_count":1184,"event_count":1219},{"regimen":"OSIMERTINIB","patient_count":1062,"event_count":1317},{"regimen":"PEMBROLIZUMAB","patient_count":745,"event_count":829},{"regimen":"GEMCITABINE","patient_count":708,"event_count":733},{"regimen":"CISPLATIN + PEMETREXED","patient_count":685,"event_count":693},{"regimen":"CARBOPLATIN + PEMBROLIZUMAB + PEMETREXED","patient_count":624,"event_count":631},{"regimen":"NIVOLUMAB","patient_count":533,"event_count":575},{"regimen":"ZOLEDRONIC ACID","patient_count":525,"event_count":1065},{"regimen":"ERLOTINIB","patient_count":483,"event_count":792},{"regimen":"MEGESTROL","patient_count":475,"event_count":530},{"regimen":"BEVACIZUMAB + CARBOPLATIN + PEMETREXED","patient_count":444,"event_count":452},{"regimen":"CARBOPLATIN + PACLITAXEL","patient_count":430,"event_count":442},{"regimen":"DOCETAXEL","patient_count":425,"event_count":436},{"regimen":"CARBOPLATIN","patient_count":392,"event_count":396},{"regimen":"BEVACIZUMAB","patient_count":319,"event_count":356},{"regimen":"DOCETAXEL + RAMUCIRUMAB","patient_count":309,"event_count":312},{"regimen":"GEMCITABINE + VINORELBINE","patient_count":306,"event_count":311},{"regimen":"PEMETREXED","patient_count":270,"event_count":285},{"regimen":"CRIZOTINIB","patient_count":266,"event_count":338},{"regimen":"DURVALUMAB","patient_count":235,"event_count":243},{"regimen":"ATEZOLIZUMAB","patient_count":196,"event_count":208},{"regimen":"ALECTINIB","patient_count":193,"event_count":221},{"regimen":"AFATINIB","patient_count":189,"event_count":209},{"regimen":"PACLITAXEL","patient_count":169,"event_count":172},{"regimen":"BEVACIZUMAB + CISPLATIN + PEMETREXED","patient_count":157,"event_count":157},{"regimen":"PACLITAXEL PROTEIN-BOUND","patient_count":152,"event_count":159},{"regimen":"CARBOPLATIN + ETOPOSIDE","patient_count":143,"event_count":155},{"regimen":"ANASTROZOLE","patient_count":135,"event_count":242},{"regimen":"IPILIMUMAB + NIVOLUMAB","patient_count":128,"event_count":132},{"regimen":"CISPLATIN","patient_count":127,"event_count":129},{"regimen":"RAMUCIRUMAB","patient_count":115,"event_count":116},{"regimen":"LORLATINIB","patient_count":109,"event_count":125},{"regimen":"BEVACIZUMAB + PEMETREXED","patient_count":108,"event_count":117},{"regimen":"VINORELBINE","patient_count":101,"event_count":102},{"regimen":"SOTORASIB","patient_count":92,"event_count":99},{"regimen":"METHOTREXATE","patient_count":89,"event_count":111},{"regimen":"CISPLATIN + ETOPOSIDE","patient_count":85,"event_count":86},{"regimen":"LETROZOLE","patient_count":81,"event_count":154},{"regimen":"CARBOPLATIN + PACLITAXEL PROTEIN-BOUND","patient_count":73,"event_count":76},{"regimen":"ETOPOSIDE","patient_count":70,"event_count":73},{"regimen":"TAMOXIFEN","patient_count":69,"event_count":151},{"regimen":"CABOZANTINIB","patient_count":69,"event_count":71},{"regimen":"CARBOPLATIN + PACLITAXEL + PEMBROLIZUMAB","patient_count":66,"event_count":66},{"regimen … (506 more chars)

▶ navigate_to_study_view
{
 "studyIds": [
  "msk_chord_2024"
 ],
 "filterAttributeId": "CANCER_TYPE",
 "filterValues": "Lung",
 "tab": "clinicalData"
}

◀ result
{"success":true,"message":"Navigating to https://www.cbioportal.org/study/clinicalData?id=msk_chord_2024&filterAttributeId=CANCER_TYPE&filterValues=Lung","url":"https://www.cbioportal.org/study/clinicalData?id=msk_chord_2024&filterAttributeId=CANCER_TYPE&filterValues=Lung","data":{"studyIds":["msk_chord_2024"],"studies":[{"studyId":"msk_chord_2024","name":"MSK-CHORD (MSK, Nature 2024)","sampleCount":25040}],"tab":"clinicalData","hasFilters":true,"hasPlotsConfig":false,"pageDescription":"Table of clinical attributes per sample."}}

═ answer (success)
## Most Frequently Administered Systemic Therapy Regimens for Lung Cancer in MSK-CHORD

Based on analysis of the MSK-CHORD Study (25,040 samples), here are the **most common systemic therapy regimens** for lung cancer patients:

### **Top 10 Systemic Therapy Regimens**

| Rank | Regimen | Patients | Type |
|------|---------|----------|------|
| 1 | **CARBOPLATIN + PEMETREXED** | 1,184 | Chemotherapy |
| 2 | **OSIMERTINIB** | 1,062 | Targeted (EGFR inhibitor) |
| 3 | **PEMBROLIZUMAB** | 745 | Immunotherapy (Anti-PD-1) |
| 4 | **GEMCITABINE** | 708 | Chemotherapy |
| 5 | **CISPLATIN + PEMETREXED** | 685 | Chemotherapy |
| 6 | **CARBOPLATIN + PEMBROLIZUMAB + PEMETREXED** | 624 | Chemo + Immunotherapy |
| 7 | **NIVOLUMAB** | 533 | Immunotherapy (Anti-PD-1) |
| 8 | **ERLOTINIB** | 483 | Targeted (EGFR inhibitor) |
| 9 | **BEVACIZUMAB + CARBOPLATIN + PEMETREXED** | 444 | Chemo + Biologic |
| 10 | **CARBOPLATIN + PACLITAXEL** | 430 | Chemotherapy |

### **Treatment Category Summary** (Most Common Agents)

- **Chemotherapy**: CARBOPLATIN (3,371 patients), PEMETREXED (3,347 patients), CISPLATIN (1,228 patients), GEMCITABINE (1,110 patients)
- **Targeted Therapies**: OSIMERTINIB (1,074 patients), ERLOTINIB (489 patients), CRIZOTINIB (276 patients)
- **Immunotherapy**: PEMBROLIZUMAB (1,569 patients), NIVOLUMAB (697 patients), ATEZOLIZUMAB (282 patients), DURVALUMAB (240 patients)
- **Biologic (Anti-VEGF)**: BEVACIZUMAB (1,036 patients), RAMUCIRUMAB (432 patients)

### **Key Insights**

1. **Platinum-based doublets** (CARBOPLATIN + PEMETREXED / CISPLATIN + PEMETREXED) are the most common backbone, representing first-line chemotherapy for non-small cell lung cancer
2. **OSIMERTINIB monotherapy** (1,062 patients) reflects its use in EGFR-mutant lung cancer
3. **Checkpoint inhibitors** (PEMBROLIZUMAB, NIVOLUMAB) combined with chemotherapy are increasingly common as first-line options
4. **Combination chemo + immunotherapy** regimens (e.g., CARBOPLATIN + PEMETREXED + PEMBROLIZUMAB with 624 patients) represent modern first-line approaches

[View filtered cohort for Lung Cancer](https://www.cbioportal.org/study/clinicalData?id=msk_chord_2024&filterAttributeId=CANCER_TYPE&filterValues=Lung)