Clinical Features Associated With Outcomes in Lung Cancer Patients Treated With Denosumab

To investigate the association between denosumab use and 2-year all-cause mortality and incident skeletal-related events (SREs) in patients with lung cancer and bone metastases.

This retrospective cohort study utilised electronic records from an international clinical database. The enrolment period was between January 1, 2010, and December 31, 2020, followed by a 2-year follow-up period. Data were extracted from TriNetX, a global clinical research platform with electronic medical records from more than 120 healthcare organisations for over 250 million patients in 19 countries. A total of 52,521 eligible patients were recruited and divided into 2 groups based on the use of denosumab. Propensity score matching (PSM) was used to balance baseline demographic and clinical characteristics between study groups. After PSM, the study and control groups each comprised 2735 patients with similar baseline characteristics. The primary outcome was all-cause mortality during the 2-year follow-up period. Incident SRE diagnoses, encompassing pathologic fractures, radiation therapy to bone, spinal cord compression, and hypercalcaemia, were examined as secondary outcomes.

During the 2-year follow-up period, overall mortality was significantly lower in the study group than in the control group (53.8% vs 55.1%; hazard ratio [HR], 0.74; 95% CI, 0.69-0.80; P < .001). The study group also had a longer median survival time (467 days vs 292 days), a higher survival probability during the follow-up period (P < .001), and a significantly lower risk of SREs (HR, 0.42; 95% CI, 0.33-0.53; P < .001). Survival benefits and reduction of SRE risk associated with denosumab were consistent across most subgroups.

In this large international cohort, patients treated with denosumab had lower mortality and fewer SREs than those who did not receive denosumab, adding to the growing body of evidence supporting its clinical benefit.