Real-world treatment and survival in early-stage NSCLC

Although adjuvant chemotherapy is recommended for patients with early-stage non-small cell lung cancer (NSCLC) following complete resection, a retrospective cohort analysis showed that the rate of adjuvant chemotherapy delivery in the real world is low. For those patients who were treated with adjuvant chemotherapy, overall survival (OS) at 5 years was higher than historical benchmarks.

About 25% of the early-stage NSCLC patients receive surgical resection, but a high rate of recurrence is still observed after complete resection [1]. Approximately 45% of patients with stage IB, 62% with stage II, and 76% with stage III NSCLC will still develop disease recurrence or die as a result of their disease within 5 years of resection [2]. The survival after complete resection remains poor, despite the advent of newer treatments [3]. Adjuvant chemotherapy is currently recommended for patients with completely resected stage II to IIIA NSCLC, as well as stage IB patients considered high-risk [4]. Compared with best supportive care following complete resection, cisplatin-based chemotherapy is associated with improvement in disease-free survival (DFS) and OS; however, improvement in OS translates to a mere absolute survival benefit of 5.4% at 5 years [2].

To understand treatment use in the adjuvant setting and predict long-term survival outcomes in patients with early-stage NSCLC following complete resection, real-world data is needed. A retrospective, non-interventional cohort study based on data from the ConcertAI Patient360™ database was performed by Dr Howard West (City of Hope Comprehensive Cancer Center, CA, USA) and co-investigators [5].

Patients with a primary diagnosis of stage IB-IIIA NSCLC were eligible if they had undergone complete resection before March 2016, to allow a minimum of an approximate 5-year theoretical follow-up. Patients who received prior neoadjuvant chemotherapy or radiotherapy were excluded. A total of 441 patients were enrolled: 153 stage IB, 183 stage II, and 105 stage IIIA.

The patient group diagnosed with stage IIIA disease had the highest proportion of patients with adjuvant chemotherapy (50.5%), followed by stage II disease (42.1%), and stage IB disease (15.7%). Among the total of 441 patients, 26 patients received a second adjuvant therapy (5.9%), and 9 patients received a third adjuvant therapy (2.0%). The most commonly used first adjuvant regimens were docetaxel/cisplatin (23.4%, 36 out of 154 patients with adjuvant therapy) and pemetrexed/ cisplatin (20.8%, 32 out of 154 patients) across all stages. The median duration of the first adjuvant therapy regimen was 2.1 months.

The median real-world DFS was 42.4 months for all patients. Median DFS for stage IB patients was 57.8 months; median DFS was similar in stage II and stage IIIA patients (36.6 and 34.4 months). The DFS rate for stage IB-IIIA was 55.2% at 3 years and 42.1% at 5 years.

The median real-world OS was 83.1 months for stage IB-IIIA patients. Median OS for stage IB disease patients was 86.5 months, 79.4 months for stage II, and 71.7 months for stage IIIA patients. The 5-year OS rate for stage IB-IIIA patients was 65.7%. The highest 5-year OS rate was observed for patients with stage IB disease (see Figure).

Figure: Overall survival after complete resection by stage [5]



Dr West summarised that, although adjuvant chemotherapy is recommended by clinical guidelines, the rate of adjuvant chemotherapy delivery was low in this patient sample with early-stage NSCLC following complete resection. OS rate at 5 years was higher for stage II and stage IIIA patients who were treated with adjuvant chemotherapy than historical benchmarks.

1. Friedlaender A, et al. Int J Mol Sci 2020;21:6329.


2. Pignon JP, et al. J Clin Oncol. 2008;26:3552–3559.


3. Bugge AS, et al. Eur J Cardiothorac Surg 2018;53:221–227.


4. Postmus PE, et al. Ann Oncol. 2017 Jul 1;28(suppl_4):iv1-iv21.


5. West H, et al. Treatment patterns, overall survival (OS), and disease-free survival (DFS) in early stage non-small cell lung cancer (NSCLC) following complete resection. Abstract 89P. ELCC 2022 Virtual Meeting, 30 March–02 April.

 

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Posted on 25 May, 2022