Recent Survival Gains in Stage IV NSCLC by Sociodemographic Strata

The management of stage IV NSCLC has been transformed by recent innovations. Nevertheless, access to medical innovations varies across sociodemographic groups in the United States, which may affect the rate of outcome improvements. Our objective was to evaluate the recent real-world gains in the survival of patients with stage IV NSCLC across sociodemographic groups.

The National Cancer Database was queried for treated patients diagnosed with stage IV NSCLC between 2010 and 2020. Data was analyzed in three eras (2010-2013, 2014-2017, and 2018-2020). Two-year survival was assessed using the Kaplan-Meier method. Adjusted mortality risk was calculated using stratified Cox analysis.

A total of 393,586 patients with stage IV NSCLC received treatment. Chemotherapy administration decreased (from 64.8% to 25.1%), radiation therapy decreased (from 54.3% to 27.6%), and immunotherapy increased (from 2.0% to 51.8%). Between eras 1 and 3, median survival increased by 53.7% (6.7-10.3 mo); nevertheless, not all groups improved at the same pace. The median survival increased by 81% (from 8.3 to 15.0 mo) for Hispanic patients, by 54.7% (from 6.7 to 10.3 mo) for non-Hispanic Blacks, and by 46.7% (from 6.6 to 9.6 mo) for non-Hispanic Whites. The median survival of uninsured patients increased from 5.8 to 7.2 months (24.1%), whereas that of patients with private insurance increased from 8.6 to 14.7 months (70.9%).

The survival of patients with treated stage IV NSCLC has improved considerably over the past decade. Nevertheless, expected survival and the pace of improvement differed across sociodemographic groups. Further studies to understand this outcome variability may enhance the effectiveness and equity of NSCLC treatments.