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Real-World Treatment Patterns and Clinical Outcomes Among Chinese Patients with Stage III NSCLC: The MOOREA Study

Ligang Xing¹, Jinming Yu², Xiangjiao Meng²

¹Department of Radiation Oncology, Shandong Cancer Hospital, No. 440 Jiyan Road, Jinan City, Shandong Province, China. xinglg@medmail.com.cn.

Targeted Oncology

|May 3, 2026

Abstract

Background:

Stage III non-small cell lung cancer (NSCLC) presents marked heterogeneity under evolving therapeutic paradigms. Real-world evidence on current treatment practices and outcomes remains limited.

Objective:

The MOOREA study aimed to evaluate real-world molecular testing, treatment patterns, and clinical outcomes of treatment-naïve Chinese patients with stage III NSCLC.

Patients And Methods:

MOOREA is a prospective, multicenter Chinese study enrolling patients with untreated stage III NSCLC (16 July 2019 to 28 February 2022) from 28 hospitals. Patients were consecutively enrolled. The primary endpoint was treatment pattern of cohort 1 (C1; unresectable stage III NSCLC), and the secondary endpoints included molecular testing pattern, progression-free survival (PFS), overall survival (OS) of C1, and treatment pattern of cohort 2 (C2; resectable stage III NSCLC).

Results:

In total, 486 patients were analyzed (C1: 379; C2: 107). Molecular testing rates were: EGFR (20.0%), ALK (15.0%), and PD-L1 (13.0%). Of the 45.6% (173/379) of individuals in C1 who received chemoradiotherapy (CRT), 53.8% (93/173) underwent consolidation therapy, including 37.6% (35/93) who received immunotherapy (IO). In C2, lobectomy was the main surgical approach (85.8%, 91/106), whereas pneumonectomy was performed on 14.2% of patients (15/106). Adjuvant treatment was planned for 71.4% (75/105) of the patients in C2. For C1, the median follow-up was 27.5 months, with PFS and OS of 12.6 (95% CI: 11.0-14.0) and 33.3 months (95% CI: 29.6-not estimable), respectively. Subgroup analysis showed better OS and PFS for patients receiving CRT with IO consolidation versus CRT only, especially for those who underwent more than six IO consolidation cycles (24-month OS: 79.3% versus 66.4%; PFS: 49.6% versus 24.2%).

Conclusions:

MOOREA reveals the real-world management of stage III NSCLC in 20 provinces/cities in mainland China and Hong Kong SAR. Patients with unresectable tumors derived significant benefit from radiotherapy and consolidation after CRT. Substantial disparity persists between actual practice and guideline recommendations, necessitating efforts to enhance adherence to guideline-based care.

Clinical Trial Registration:

NCT04023812.

Insights

The MOOREA study shows that stage III non-small cell lung cancer (NSCLC) patients benefit from chemoradiotherapy (CRT) with immunotherapy (IO) consolidation. However, real-world treatment patterns in China reveal disparities with guideline recommendations.

Area of Science:

Oncology
Clinical Research
Thoracic Surgery

Background:

Stage III non-small cell lung cancer (NSCLC) exhibits significant heterogeneity, with evolving treatment strategies.
Limited real-world data exists on current treatment practices and outcomes for NSCLC in China.

Purpose of the Study:

To assess real-world molecular testing, treatment patterns, and clinical outcomes.
To evaluate treatment-naïve Chinese patients with stage III NSCLC.

Main Methods:

Prospective, multicenter study of 486 untreated stage III NSCLC patients in China (July 2019-Feb 2022).
Primary endpoint: treatment patterns in unresectable (C1) and resectable (C2) cohorts.
Secondary endpoints: molecular testing, progression-free survival (PFS), and overall survival (OS) in C1.

Main Results:

Molecular testing rates: EGFR (20.0%), ALK (15.0%), PD-L1 (13.0%).
In C1, 45.6% received chemoradiotherapy (CRT); 53.8% of these had consolidation therapy, including 37.6% with immunotherapy (IO).
For C1, median PFS was 12.6 months, median OS was 33.3 months. CRT with IO consolidation showed improved OS and PFS versus CRT alone.

Conclusions:

MOOREA provides real-world insights into stage III NSCLC management in China.
Patients with unresectable tumors benefit from CRT and consolidation therapy.
Significant gaps exist between current practices and guidelines, highlighting the need for improved adherence.

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