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Advanced stage at diagnosis linked to worse lung adenocarcinoma OS
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Stage of disease at the time of diagnosis was independently associated with OS among patients with KRAS-mutant and EGFR-mutant lung adenocarcinomas, according to study results.
Advanced disease stage at the time of diagnosis generally resulted in shorter survival rates, results showed.
“Clinical trials of systemic therapies typically do not distinguish between those patients with metastatic disease at the time of diagnosis vs. those with recurrent metastatic disease,” Helena A. Yu, MD, of the division of solid tumor oncology in the department of medicine at Memorial Sloan Kettering Cancer Center, and colleagues wrote. “To our knowledge, it is unknown whether stage of disease at the time of the initial diagnosis is a prognostic marker that impacts survival from the time of diagnosis of metastatic disease.”
Yu and colleagues evaluated data from 635 patients (median age, 66 years) with metastatic KRAS-mutant lung adenocarcinomas and 496 patients (median age, 63 years) with metastatic EGFR-mutant lung adenocarcinomas. A majority of the patients were women in the KRAS (61%) and EGFR (66%) cohorts.
Seventy-four percent of EGFR-mutant and 61% of KRAS-mutant patients were diagnosed with de novo metastatic disease. Researchers noted there were no differences with respect to age, sex, smoking history and Karnofsky performance status between patients with de novo metastatic and recurrent metastatic disease.
Results showed patients with de novo metastatic KRAS-mutant lung adenocarcinomas had a shorter median OS than patients with recurrent metastatic disease (12 vs. 18 months; P = .002). Results of a multivariate analysis indicated Karnofsky performance status of 70 or less vs. 80 or higher (HR = 2.28; 95% CI, 1.79-2.89) and recurrent vs. de novo metastatic disease (HR = 1.41; 95% CI, 1.15-1.74) were significantly associated with OS.
Among EGFR-mutant patients, unadjusted analyses indicated OS was similar among patients with de novo vs. recurrent metastatic disease (30 vs. 32 months). However, in a multivariate analysis controlled for age and Karnofsky performance status, patients with de novo metastatic disease demonstrated shorter OS compared with patients with recurrent metastatic disease (HR = 1.36; 95% CI, 1.05-1.76).
“In future studies of patients with recurrent or metastatic lung adenocarcinomas, stage of disease at the time of diagnosis should be recorded and stratification based on this clinical characteristic considered in phase 3 studies,” Yu and colleagues concluded. “Stage at diagnosis should be noted as a prognostic factor when interpreting treatment and survival outcomes on clinical trials.” – by Cameron Kelsall
Disclosure: Yu reports research funding from and consultant roles with Astellas, AstraZeneca, Clovis Oncology, Incyte and Pfizer. Please see the full study for a list of all other researchers’ relevant disclosures.
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