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Published on: October 23, 2020
Changes in survival of patients with non-small cell lung cancer in Japan: An interrupted time series study
Yukari Taniyama1, Isao Oze2, Yuriko N Koyanagi1
1Division of Cancer Information and Control, Department of Preventive Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan.
Abstract:
The epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) gefitinib and erlotinib were approved for metastatic or relapsed non-small cell lung cancer (NSCLC) in Japan in 2002 and 2007, respectively. EGFR mutation testing was also approved in 2007. Although clinical trials showed efficacy in NSCLC patients harboring activating EGFR mutations, these effects have rarely been reported in real-world practice. We evaluated changes in survival in NSCLC patients following introduction of these agents and EGFR mutation testing by extracting patients diagnosed with NSCLC from 1993 through 2011 from six prefectural population-based cancer registries in Japan. Relative survival (RS) was calculated by sex, histological subtype, and cancer stage. We conducted interrupted time series analysis to assess survival changes following introduction of EGFR-TKIs and EGFR mutation testing. 120,068 patients with NSCLC were analyzed. One- and three-year RS gradually increased in overall NSCLC for men and women. For adenocarcinoma, among men, slopes of 1- and 3-year RS increased steeply in patients diagnosed from 2007 through 2011; among women, significant level increases were seen in 1-year RS in patients diagnosed in 2002 (4.55% [95% confidence interval: 1.76-7.33]) and 2007 (3.40% [1.27-5.52]). These significant level increases were particularly obvious in women with adenocarcinoma at an advanced stage. Our results suggest that recent improvements in survival in men and women with adenocarcinoma are due at least partly to introduction of EGFR-TKIs into real-world practice, and to prescription based on appropriate patient selection following introduction of EGFR mutation testing into real-world practice in Japan.
Insights
Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) improved survival for non-small cell lung cancer (NSCLC) patients in Japan. Introduction of EGFR-TKIs and mutation testing correlated with better real-world outcomes, especially for adenocarcinoma.
Area of Science:
- Oncology
- Public Health
- Pharmacoeconomics
Background:
- Gefitinib and erlotinib (EGFR-TKIs) were approved for metastatic or relapsed non-small cell lung cancer (NSCLC) in Japan in 2002 and 2007.
- EGFR mutation testing approval in 2007 aimed to guide treatment selection.
- Real-world effectiveness of EGFR-TKIs in NSCLC patients with EGFR mutations remained under-reported.
Purpose of the Study:
- To evaluate survival changes in NSCLC patients following the introduction of EGFR-TKIs and EGFR mutation testing in Japan.
- To assess the real-world impact of these targeted therapies and diagnostic tools on patient survival.
- To analyze survival trends across different patient demographics and disease stages.
Main Methods:
- Utilized data from six prefectural population-based cancer registries in Japan, covering NSCLC patients diagnosed between 1993 and 2011.
- Calculated relative survival (RS) rates stratified by sex, histological subtype, and cancer stage.
- Employed interrupted time series analysis to detect survival changes post-introduction of EGFR-TKIs and mutation testing.
Main Results:
- Analyzed 120,068 NSCLC patients, observing gradual increases in 1- and 3-year RS for both men and women.
- Identified steep increases in 1- and 3-year RS for male adenocarcinoma patients diagnosed from 2007-2011.
- Observed significant level increases in 1-year RS for female adenocarcinoma patients, particularly those with advanced-stage disease, following drug and testing introductions.
Conclusions:
- Recent survival improvements in Japanese NSCLC patients, especially with adenocarcinoma, are partly attributed to the real-world implementation of EGFR-TKIs.
- Appropriate patient selection through EGFR mutation testing has likely enhanced the effectiveness of these targeted therapies in clinical practice.
- The study highlights the positive impact of targeted therapy introduction and companion diagnostics on population-level cancer survival outcomes.
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