BACKGROUND: Non-small cell lung cancer (NSCLC) commonly presents at advanced stage. We previously reported systemic treatment uptake in stage IV NSCLC climbing from 55% (2009-2012) to 62% (2015-2017). Since then, first-line immunotherapy and 2nd/3rd generation tyrosine kinase inhibitors (TKIs) have emerged as standards of care. We explored whether treatment rates continued to rise and studied outcomes. METHODS: We reviewed all cases of de novo stage IIIB/IIIC/IV NSCLC seen in out-patient medical oncology consultation at our institution between 2009-2012 (cohort A), 2015-2017 (cohort B), and June-December 2018 (cohort C). We compared rates of systemic treatment, molecular testing, targeted therapy, and immune checkpoint inhibitor (ICI) use. We compared survival in the overall, treated/untreated, younger and elderly population in cohort A vs. cohort B + C (=cohort D). RESULTS: Cohorts A, B, and C included 528, 463, and 93 patients, respectively. Overall, 66% received any systemic therapy in cohort C, compared to 62% in cohort B and 55% in cohort A. Across three time periods, first-line chemotherapy rates fell (93, 76, 46%) while rates of first-line targeted therapy (5, 16, 15%) and ICI (0, 2, 36%) rose. Among molecular subtypes, first-line targeted treatment in EGFR-positive patients (63, 94, 100%) and anaplastic lymphoma kinase (ALK)-positive patients (0, 91, 100%) rose. Survival improved in all subgroups in cohort D vs. cohort A, except for patients ≥ 70 years and the untreated population. CONCLUSIONS: Systemic treatment rose across three time periods, reflecting the introduction of rapid diagnostic pathways, reflex molecular testing, ICI, and targeted therapies. Survival outcomes of advanced NSCLC patients have significantly improved.
BACKGROUND:Non-small cell lung cancer (NSCLC) commonly presents at advanced stage. We previously reported systemic treatment uptake in stage IV NSCLC climbing from 55% (2009-2012) to 62% (2015-2017). Since then, first-line immunotherapy and 2nd/3rd generation tyrosine kinase inhibitors (TKIs) have emerged as standards of care. We explored whether treatment rates continued to rise and studied outcomes. METHODS: We reviewed all cases of de novo stage IIIB/IIIC/IV NSCLC seen in out-patient medical oncology consultation at our institution between 2009-2012 (cohort A), 2015-2017 (cohort B), and June-December 2018 (cohort C). We compared rates of systemic treatment, molecular testing, targeted therapy, and immune checkpoint inhibitor (ICI) use. We compared survival in the overall, treated/untreated, younger and elderly population in cohort A vs. cohort B + C (=cohort D). RESULTS: Cohorts A, B, and C included 528, 463, and 93 patients, respectively. Overall, 66% received any systemic therapy in cohort C, compared to 62% in cohort B and 55% in cohort A. Across three time periods, first-line chemotherapy rates fell (93, 76, 46%) while rates of first-line targeted therapy (5, 16, 15%) and ICI (0, 2, 36%) rose. Among molecular subtypes, first-line targeted treatment in EGFR-positive patients (63, 94, 100%) and anaplastic lymphoma kinase (ALK)-positive patients (0, 91, 100%) rose. Survival improved in all subgroups in cohort D vs. cohort A, except for patients ≥ 70 years and the untreated population. CONCLUSIONS: Systemic treatment rose across three time periods, reflecting the introduction of rapid diagnostic pathways, reflex molecular testing, ICI, and targeted therapies. Survival outcomes of advanced NSCLCpatients have significantly improved.
Authors: D Planchard; S Popat; K Kerr; S Novello; E F Smit; C Faivre-Finn; T S Mok; M Reck; P E Van Schil; M D Hellmann; S Peters Journal: Ann Oncol Date: 2018-10-01 Impact factor: 32.976
Authors: A F T Verhagen; G P Bootsma; V C G Tjan-Heijnen; G J van der Wilt; A L Cox; M H J Brouwer; F H M Corstens; W J G Oyen Journal: Lung Cancer Date: 2004-05 Impact factor: 5.705
Authors: Luis Paz-Ares; Alexander Luft; David Vicente; Ali Tafreshi; Mahmut Gümüş; Julien Mazières; Barbara Hermes; Filiz Çay Şenler; Tibor Csőszi; Andrea Fülöp; Jerónimo Rodríguez-Cid; Jonathan Wilson; Shunichi Sugawara; Terufumi Kato; Ki Hyeong Lee; Ying Cheng; Silvia Novello; Balazs Halmos; Xiaodong Li; Gregory M Lubiniecki; Bilal Piperdi; Dariusz M Kowalski Journal: N Engl J Med Date: 2018-09-25 Impact factor: 91.245
Authors: B Melosky; N Blais; P Cheema; C Couture; R Juergens; S Kamel-Reid; M-S Tsao; P Wheatley-Price; Z Xu; D N Ionescu Journal: Curr Oncol Date: 2018-02-28 Impact factor: 3.677
Authors: Aria Shokoohi; Zamzam Al-Hashami; Sara Moore; Alexandra Pender; Selina K Wong; Ying Wang; Bonnie Leung; Jonn Wu; Cheryl Ho Journal: Cancer Med Date: 2021-11-16 Impact factor: 4.452