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S.D. Ramsey

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    P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P2.01-040 - Survival Gains From Systemic Therapy in Advanced Non-Small Cell Lung Cancer in the U.S., 1990-2015: Progress and Opportunities (ID 1563)

      09:30 - 17:00  |  Author(s): S.D. Ramsey

      • Abstract

      Approximately 180,000 Americans are diagnosed with non-small cell lung cancer (NSCLC) annually, and more than half have advanced (Stage IIIB/IV) disease. Historically, survival for these patients has been poor. Moreover, even though standard systemic therapies (e.g. platinum-doublet chemotherapy) provide a modest survival advantage, a substantial proportion(~60%) of patients do not initiate or complete treatment. The advent of newer systemic therapies with more favorable effectiveness and toxicity profiles affords opportunities to improve NSCLC outcomes. The objectives of this study were: 1)to quantify survival gains from 1990-2015, ranging from a period when best supportive care(BSC) only was standard, to the present, where multiple cytotoxic and targeted therapies are available, and 2)to project the potential impact of increasing use of modern systemic therapies in clinically appropriate patients.

      We developed a simulation model to estimate observed and potential survival gains for patients diagnosed with advanced NSCLC in 1990 and 2015. Survival inputs were derived from Phase III clinical trials referenced in National Comprehensive Cancer Network guidelines, and extrapolated to a lifetime horizon by fitting Weibull curves. Proportions of patients receiving available therapies were derived from SEER (for % receiving BSC only) and a commercial treatment registry. Outcomes included one-year survival proportion, mean expected overall survival(OS), expected OS if the proportion receiving systemic therapy is increased by 10% (“Scenario 1”) and 30% (“Scenario 2”) relative to current use, and population-level estimates of total life years. Results were calibrated with SEER overall survival curves. Annual incidence of advanced NSCLC was assumed to be 92,000 in both years.

      In the expected survival analysis, from 1990 to 2015, one-year survival proportion increased by 15.8% and mean per-patient survival improved by 4.3 months (33,412 population life years)(Table 1). In scenarios 1 and 2, the improvement in survival increased to 4.6 months (35,684 population life years) and 5.2 months (40,279 population life years), respectively. Considering the proportion receiving each treatment, and the size of overall survival treatment effects, the majority of the survival gains were attributable to the advent of platinum-doublet chemotherapy (49%), followed by EGFR (35%), VEGF (10%), and ALK (6%) targeted therapies.

      Table 1: Advanced non-small cell lung cancer outcomes by year of diagnosis.
      Diagnosis Year Expected: One-Year Survival (%) Expected: Mean Per-Patient Survival (Months) Expected: Population Life Years Scenario 1: Population Life Years with 10% Relative Increase in Proportion Treated Scenario 2: Population Life Years with 30% Relative Increase in Proportion Treated
      2015 29.3% 11.4 87,287 89,559 95,154
      1990 13.5% 7.1 53,875 53,875 53,875
      Difference +15.8% +4.3 +33,412 +35,684 +40,279

      Though survival remains poor in advanced NSCLC relative to other common cancers, meaningful progress in per-patient and population-level outcomes has been realized over the past 25 years. These advances can be improved even further by increasing use of systemic therapies in the substantial proportion of patients who are suitable for treatment, yet currently receive BSC only.