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Real-World Treatment Patterns and Outcomes Among Patients with Early Non-Small Cell Lung Cancer
Jennifer D Deem1, Zsolt Hepp2, Joshua J Carlson1
1CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA 98195, USA.
Abstract:
Worldwide, about two million people are diagnosed with lung cancer each year, 85% of whom have non-small cell lung cancer (NSCLC). Recent progress in treating advanced/metastatic NSCLC with targeted therapies has shifted attention to early NSCLC (Stages I-IIIA) and perioperative (neoadjuvant and adjuvant) systemic therapies. However, our comprehension of how targeted therapeutics are incorporated into care and their impact on patient outcomes is just starting to unfold.
Methods:
This retrospective observational study used a US nationwide electronic health record-derived deidentified database spanning January 2019-March 2024 and aimed to describe (1) eNSCLC patient demographic and clinical characteristics, (2) real-world neoadjuvant and adjuvant use, and (3) patient outcomes.
Results:
The study population included 4841 Stage IB-IIIA NSCLC patients with a mean age of 70.9 ± 8.6 years. The majority (69.9%) received definitive treatment: surgery (n = 2280), definitive radiation (n = 320), or definitive chemoradiation (n = 783), while 30.1% (n = 1458) did not. Many definitive treatment patients received some perioperative systemic therapy (surgery: 52.6%, radiation: 52.2%, chemoradiation: 75.5%). Neoadjuvant use was limited in all groups (surgery: 8.2%, radiation: 6.1%, chemoradiation: 11.6%). Among the 54.6% receiving adjuvant, immune checkpoint inhibitors were the most common choice for definitive radiation (39.1%) and chemoradiation (73.7%) patients, while surgical patients predominantly received platinum-doublet therapy (37.0%). Surgical patient outcomes were similar across all groups, while definitive chemoradiation or radiation patients without systemic therapy had lower survival rates.
Conclusions:
In this study, we found that although the majority of patients underwent some form of definitive treatment, adjuvant use was limited, and neoadjuvant use was rarely included in care. A crucial initial step in improving patient outcomes is to understand and address the underutilization of neoadjuvant/adjuvant systemic therapy for eNSCLC patients.
Insights
Perioperative systemic therapy use in early non-small cell lung cancer (NSCLC) is limited, especially neoadjuvant treatment. Addressing this underutilization is key to improving survival rates for early NSCLC patients.
Area of Science:
- Oncology
- Clinical Research
- Public Health
Background:
- Non-small cell lung cancer (NSCLC) accounts for 85% of lung cancer diagnoses globally, with a significant focus shifting towards early-stage disease (Stages I-IIIA).
- Perioperative (neoadjuvant and adjuvant) systemic therapies are increasingly recognized for their potential in treating early NSCLC.
- Understanding the real-world application and impact of these therapies is crucial for optimizing patient care.
Purpose of the Study:
- To describe the demographic and clinical characteristics of early NSCLC patients.
- To evaluate the real-world utilization patterns of neoadjuvant and adjuvant systemic therapies in early NSCLC.
- To assess the impact of these therapies on patient outcomes.
Main Methods:
- Retrospective observational study utilizing a US nationwide deidentified electronic health record database (January 2019-March 2024).
- Analysis of patient demographics, clinical characteristics, treatment modalities (surgery, radiation, chemoradiation), and perioperative systemic therapy use.
- Comparison of patient outcomes, including survival rates, based on treatment received.
Main Results:
- The study included 4841 Stage IB-IIIA NSCLC patients (mean age 70.9 years).
- While most patients received definitive treatment, neoadjuvant therapy use was low across all treatment groups (6.1%-11.6%). Adjuvant therapy was utilized by 54.6% of patients.
- Immune checkpoint inhibitors were common adjuvant choices for radiation/chemoradiation patients, while platinum-doublet therapy was prevalent for surgical patients. Patients receiving definitive treatment without systemic therapy showed lower survival rates.
Conclusions:
- The majority of early NSCLC patients received definitive treatment, but perioperative systemic therapy, particularly neoadjuvant, remains underutilized.
- Adjuvant therapy use, while more common than neoadjuvant, also presents an opportunity for increased application.
- Addressing the underutilization of neoadjuvant and adjuvant systemic therapies is a critical step toward improving survival outcomes for early-stage NSCLC patients.
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