BACR 4: Outcomes in stage IV non-small cell lung cancer treatment: an observational study.
1Clatterbridge Cancer Centre, Liverpool, UK,2University of Liverpool, Liverpool, UK
Conveyance of survival benefit from the clinical trial setting into the real-life population remains a challenge in oncology practice. Novel systemic therapeutic strategies for non-small cell lung cancer (NSCLC) management have found a niche in standard practice over recent years. Here we aimed to contextualize their impact by assessing the changes implemented in our cancer centre and their combined effect on overall survival in our stable population.
We focused on patients treated for stage IV disease, where systemic drug therapy is the backbone treatment. Two groups of patients that started treatment within a two-year period before and after therapy changes were identified in our prospective database. We discerned therapeutic changes, quantified prospective surrogate toxicity indicators, and used Log-rank test to compare overall survival.
253 patients started systemic treatment between 2002 and 2004, and 325 between 2010 and 2012. These represent 33% and 34% of patients referred to our centre with stage IV NSCLC in each time period. In the first line, Cisplatin use increased from 4% to 20.5%, and EGFR inhibitors were used only in 7% of patients. Within ten years the proportion of patients that received second line treatment doubled from 15% to 30%. In 2010-12, 9% had maintenance Pemetrexed and 52% EGFR inhibitors, at the expense of an increase in early discontinuation rates from 37% to 46%. The one-year survival rate of treated stage IV NSCLC patients was stable at 34% and 32%, respectively. There were no significant differences in overall survival.
Our results suggest a large proportion of patients with advanced disease are still not amenable to systemic treatment, and indicate a small proportion of real-life patients benefit from novel strategies without influencing population survival. This highlights the need for sub-specialized care delivery monitoring and optimization as new therapeutic strategies are adopted.