VALO NSCLC pilot study

Summary

This pilot study demonstrates the technical feasibility of conducting federated OMOP-based analytics across Nordic healthcare systems. This proof-of-concept pilot analysed real-world treatment patterns and outcomes for 755 patients with metastatic non-small cell lung cancer (mNSCLC) receiving first-line immunotherapy in Denmark, Finland and Norway.

Key results

• The pilot successfully implemented a privacy-preserving federated analysis infrastructure using the OMOP common data model.
• Notable differences were observed in treatment patterns and survival outcomes across sites, with median overall survival ranging from approximately 315 to 542 days, highlighting variability that may stem from data capture and patient selection rather than true clinical differences.

Critical limitations

• Major data completeness gaps were observed: ECOG performance status absent in two sites, smoking history universally missing, and heterogeneous PD-L1 reporting.
• Incomplete radiotherapy documentation and reliance on proxy measures for chemotherapy cycles.
• Selection bias and care fragmentation limit generalisability; observed differences cannot be interpreted as healthcare system or treatment effectiveness.

Implications and next steps

This pilot serves primarily as a methodological milestone rather than a source of actionable clinical evidence. It identifies critical prerequisites for future Nordic collaboration: standardised capture of prognostic covariates, validated algorithms for key classifications (emergent versus de novo disease), harmonised treatment intent and documentation, and prospective data quality monitoring.

The successful execution of this pilot, despite documented data limitations, validates the core premise that Nordic healthcare systems can collaborate effectively through federated OMOP infrastructure. Subsequent studies with prospectively standardised covariate capture, particularly ECOG performance status, smoking history and PD-L1 expression, will be positioned to generate clinically actionable evidence regarding optimal mNSCLC treatment strategies across Nordic healthcare systems.