Effect of targeted therapy and immunotherapy on advanced nonsmall-cell lung cancer outcomes in the real world.
Aria ShokoohiZamzam Al-HashamiSara MooreAlexandra PenderSelina K WongYing WangBonnie LeungJonn WuCheryl HoPublished in: Cancer medicine (2021)
The evolution of diagnosis and treatment of advanced nonsmall-cell lung cancer (NSCLC) has led to increasing the use of targeted therapy and immune checkpoint inhibitors. The study goal was to assess the effect of molecular testing and the introduction of new therapies on overall survival (OS). All patients with stage IV NSCLC referred to BC Cancer were included in the study. Four 1-year time cohorts were created based on molecular testing implementation and funded drug availability: C1 baseline (2009), C2 EGFR TKI access (2011), C3 ALK inhibitor access (2015), C4 immunotherapy availability (2017). Baseline demographics, disease characteristics, and systemic therapy details were collected retrospectively. OS was calculated using the Kaplan-Meier method and compared using the log-rank test. There were 3421 patients identified with stage IV NSCLC and 1319 (39%) received systemic therapy. In the four 1-year time cohorts C1/C2/C3/C4: driver mutation-targeted treatment increased 1/17/27/34% (of total systemic therapy), as did treatment with any line immunotherapy <1/1/9/38%. Median OS with best supportive care (BSC) was 3.4/3.1/3.2/2.9 m (p = 0.16) and with systemic treatment 9.9/10.9/13.9/15.0 m (p < 0.001). Median OS by treatment exposure was BSC 3.1 m, chemotherapy only 7.3 m, targeted therapy 17.5 m, and immunotherapy 20.7 m. In our real-world study, following the introduction of targeted therapy and immune checkpoint inhibitors, there was a significant improvement in OS in each successive time cohort concordant with advancements in therapeutic options.
Keyphrases
- small cell lung cancer
- healthcare
- advanced non small cell lung cancer
- epidermal growth factor receptor
- cell therapy
- squamous cell carcinoma
- emergency department
- palliative care
- metabolic syndrome
- single cell
- end stage renal disease
- adipose tissue
- drug delivery
- drug induced
- chronic kidney disease
- radiation therapy
- chronic pain
- newly diagnosed
- locally advanced
- cancer therapy
- single molecule
- skeletal muscle
- glycemic control
- peritoneal dialysis
- rectal cancer