Trends in treatment and survival of stage IV non‑squamous NSCLC from 2010 to 2022

Rákkutatás · NSCLC

Modern regimens were associated with improved survival in stage IV NS‑NSCLC, but long‑term survival remains poor, underscoring the need for further research.

Advances in immunotherapy (IT) and targeted therapy have transformed treatment for stage IV non‑squamous non‑small cell lung cancer (NS‑NSCLC). However, real‑world data comparing modern regimens to previous standards remains limited. Herein, we aim to determine whether survival outcomes have improved with contemporary therapies, We conducted a retrospective analysis of de novo stage IV NS‑NSCLC at diagnosis treated at the Cleveland Clinic, OH, from 1/2010 to 12/2022. Baseline variables, including age, sex, race, performance status, smoking history, PD‑L1 testing, and molecular profiling, were collected along with treatment regimens. Treatment responses were assessed. Overall survival (OS) and progression‑free survival (PFS) were estimated. Multivariable Cox regression (CPH) was used to adjust for confounding. We identified 1,518 patients with NS‑NSCLC, of which 97% had adenocarcinoma (N = 1,472). Median age was 65 (IQR 58–73); 51% were female, 82% white, and 42% current smokers. Treatments included conventional chemotherapy (CTX) (744, 49%), IT (186, 12%), CTX + IT (318, 21%), and targeted therapy (270, 18%). Common regimens were carboplatin + pemetrexed/paclitaxel (502, 80%) and bevacizumab + carboplatin + pemetrexed/paclitaxel (127, 20%) for CTX, pembrolizumab (167, 89%) for IT, and carboplatin + pemetrexed + pembrolizumab (153, 41%) for chemo‑IT. Overall disease control rate was 58% with a median follow‑up of 69.7 months. The 2‑ and 5‑year OS were 30% and 12%, respectively. OS improved from 20% (2010–2012) to 38% (2019–2022) (P < 0.05). Modern regimens were associated with a 23% reduced hazard of death (HR 0.77, 95% CI 0.66–0.90, p < 0.001). Modern regimens were associated with improved survival in stage IV NS‑NSCLC, but long‑term survival remains poor, underscoring the need for further research.

The claim highlights that contemporary therapies, including immunotherapy and targeted agents, have significantly improved overall survival for patients with stage IV NS‑NSCLC compared to older standard‑of‑care regimens. While the survival benefit is evident, the persistence of poor long‑term outcomes emphasizes the ongoing therapeutic challenges and the need for additional research and therapeutic innovations in this patient population.

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