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Marjory Charlot
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P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.16-10 - Advances in Diagnosis and Treatment of Non-Small Cell Lung Cancer Are Translating into Real-World Survival Gains in the United States (ID 2932)
10:15 - 18:15 | Author(s): Marjory Charlot
- Abstract
Background
The last two decades have been notable for advances in the histologic and molecular classification of non-small cell lung cancer (NSCLC) as well as the introduction of new cytotoxic agents, targeted therapies and immunotherapy into the routine care of metastatic NSCLC based on clinical trial results. We sought to evaluate temporal trends in overall survival (OS) among unselected patients with metastatic NSCLC in the United States (US).
Method
We utilized the Surveillance, Epidemiology, and End Results (SEER) 9 registries in identifying patients with new diagnoses of stage IV NSCLC. Staging was based on the American Joint Committee on Cancer (AJCC) 3rd and 6th edition staging guidelines for the periods 1986-2003 and 2004-2015, respectively. We calculated median OS over successive 5 year intervals (1986-1990; 1991-1995; 1996-2000; 2001-2005; 2006-2010; 2011-2015) according to the year of initial diagnosis for the entire cohort as well as by subgroups defined by age (20-44 years[y]; 45-64y; 65-74y; 75-84y; ≥85y); gender (male; female); race/ethnicity (Whites; Blacks; Hispanics; Others); region (northeast; south; midwest; west); and histology (adenocarcinoma[AC]; squamous cell carcinoma[SCC]; others). Univariate analysis was performed with Kaplan-Meier analysis and log-rank tests. Independent associations between OS and time periods were examined with a multivariate Cox proportional hazard model that adjusted for the effects of age, gender, race, region, histology, as well as the interaction of time with these covariates.
Result
There were 113,518 cases of newly diagnosed stage IV NSCLC. Median OS increased from 4 months (m) in 1986-1995 to 7m in 2011-2015. Median OS improved for all age-groups and by subcategories of gender, race/ethnicity, region, and histology. Multivariate analysis demonstrated a progressive decrease in mortality since the 2000s, relative to those diagnosed in 1986-1990 with the following adjusted hazard ratios (aHR) and respective confidence intervals (CI): 1991-1995: 1.09 (95%CI: 0.93, 1.29; p=0.129); 1996-2000: 0.95 (95%CI: 0.81, 1.12; p=0.561); 2000-2005: 0.83 (95%CI: 0.71, 0.97; p=0.017); 2006-2010: 0.79 (95%CI: 0.67, 0.93; p=0.005); 2011-2015: 0.57 (95%CI: 0.48, 0.68; p<0.001). Although all subcategories of patients had improved OS over time, females had a relative improvement in OS over males in 2011-2015 compared to 1986-1990 (aHR: 0.90; 95%CI: 0.85, 0.95; p<0.001). Those aged ≥85y had OS that was comparatively worse than those aged 20-44y in 2011-2015 relative to 1986-1990 (aHR: 1.31; 95%CI: 1.04, 1.65; p=0.023). Additionally, those with SCC had worse OS than those with AC in 2011-2015 relative to 1986-1990 (aHR: 1.13; 95%CI: 1.06, 1.21; p<0.001). There were no relative differences in OS over time by race/ethnicity or region.
Conclusion
There has been a near doubling in median OS for patients diagnosed with stage IV NSCLC in the US over the 30-year period spanning 1986-2015. These findings suggest that advances in the diagnostic classification and treatment of NSCLC resulting from clinical trial participation are translating into real-world survival gains particularly for those with AC. However, patients with SCC and the most elderly patients have benefited less proportionately underscoring the need for further characterization of SCC with the development of targeted therapies and inclusion of the most elderly in cancer clinical trials.
