Evolution of Systemic Treatment Uptake and Survival in Advanced Non-Small Cell Lung Cancer

Current Oncology

Paul Wheatley-Price¹  Sophie Stock-Martineau¹  Katie Laurie²  Mathieu McKinnon²  Tinghua Zhang² 

[1] Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada;The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada;

关键词: non-small-cell lung cancer;    real-world data;    chemotherapy;    epidermal growth factor receptor;    anaplastic lymphoma kinase;    immune checkpoint inhibitor;   

DOI  :  10.3390/curroncol28010008

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown