Study reveals ‘paradigm shift’ in non-small cell lung cancer during past decade
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Key takeaways:
- Survival rates increased for all stages of NSCLC from 2016-2020 compared with 2010-2015.
- Patients with adenocarcinoma vs. those without appeared more likely to undergo molecular testing.
A study of more than 20,000 patients with non-small cell lung cancer in Korea showed improvements in survival outcomes across all stages of disease between 2010 and 2020 amid increased use of molecular testing and targeted treatments.
The results, published in JAMA Network Open, showed the greatest OS improvements among patients with stage III and stage IV NSCLC. Researchers also observed increases in the proportion of never-smokers and patients with early-stage disease.
“Collectively, the results of this large-scale cohort study may suggest a paradigm shift in diagnosis, treatment and outcomes over the past decade,” Sang Ah Chi, BS, researcher at Sungkyunkwan University’s Samsung Advanced Institute for Health Sciences and Technology in Seoul, Republic of Korea, and colleagues wrote.
Rationale and methodology
Treatment for NSCLC has continually been revolutionized during the past decade. Yet, standard clinical trials may not reflect current multiple lines of treatment and corresponding outcomes in a timely manner, according to researchers.
For this reason, Chi and colleagues sought to examine outcomes associated with new therapy among 21,978 patients (median age at diagnosis, 64.1 years; 62% men) with various stages of NSCLC who underwent any cancer treatment between Jan. 1, 2010, and Nov. 30, 2020, at Samsung Medical Center in Korea.
Researchers assessed clinical and pathological stage, histology and major druggable sequence variations between 2010 and 2015 (period 1; n = 10,110) vs. 2016 and 2020 (period 2; n = 11,868).
Three-year survival rates of NSCLC served as the primary outcome. Median OS, PFS and recurrence-free survival served as secondary outcomes.
Findings
Researchers identified adenocarcinoma as the predominant histology overall during period 1 (70.3%; n = 7,112) and period 2 (74.3%; n = 8,813). They also found the percentage of never-smokers increased from 41.8% in period 1 to 44.6% in period 2.
Molecular testing appeared more common in period 2 vs. period 1 among both patients with adenocarcinoma (97.9% vs. 79.8%) and those without adenocarcinoma (89% vs. 53.8%).
Patients with adenocarcinoma in period 1 experienced 3-year survival rates of 92.8% (95% CI, 91.8-93.7) among those with stage I disease, 72.4% (95% CI, 68.3-76.8) with stage II disease, 56.7% (95% CI, 53.4-60.2) with stage III disease and 28.7% (95% CI, 27-30.4) with stage IV disease. Among those with adenocarcinoma in period 2, researchers observed 3-year survival rates of 95.1% (95% CI, 94.4-95.9) among those with stage I disease, 82.5% (95% CI, 79.1-86.1) with stage II disease, 65.1% (95% CI, 61.8-68.6) with stage III disease and 42.4% (95% CI, 40.3-44.7) with stage IV disease.
For patients without adenocarcinoma in period 1, researchers observed 3-year survival rates of 72% (95% CI, 68.8-75.3) among those with stage I disease, 60% (95% CI, 56.2-64.1) with stage II disease, 38.9% (95% CI, 35.6-42.5) with stage III disease and 9.7% (95% CI, 7.9-12.1) with stage IV disease. Patients without adenocarcinoma in period 2 had 3-year survival rates of 79.3% (95% CI, 76.3-82.4) among those with stage I disease, 67.3% (95% CI, 62.8-72.1) with stage II disease, 48.2% (95% CI, 44.5-52.3) with stage III disease and 18.1% (95% CI, 15.1-21.6) with stage IV disease.
Study limitations included technical issues such as deidentification, missing values and biases, which may affect generalizability, according to the researchers.
Implications
“This study revealed the diversity of treatment practices and outcomes in NSCLC in a clinical setting,” Chi and colleagues wrote. “This cohort study may continue to serve as the foundation for the future development of large-scale, timely cohorts in routine clinical practice.”
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