A Multicenter Retrospective Study on the Prognosis of Stage III Unresectable Mutant Non-Small Cell Lung Cancer With Tyrosine Kinase Inhibitors Therapy.

Ranpu Wu,Jinjun Ye,Jinjun Ye,Zhiting Zhao,Shaorong Yu,Yimin Wang,Yimin Wang,Hongbing Liu,Hongbing Liu,Hongbing Liu,Yong Song,Yong Song,Yong Song

doi:10.3389/fonc.2021.692703

Abstract

BackgroundFor unresectable stage III non-small cell lung cancer (NSCLC), concurrent chemoradiotherapy is nowadays the standard treatment. Patients with advanced NSCLC harboring driver-gene mutations benefit from Tyrosine Kinase Inhibitors (TKIs) Therapy. In a real-world setting, there is room for exploring the benefit of TKIs in stage III unresectable NSCLC patients with mutation.MethodsA total of 81 patients from the Jinling Hospital and the Jiangsu Cancer Hospital with stage III unresectable mutant NSCLC applied targeted therapy were enrolled in this retrospective study. Patients with first-line application of TKIs were followed up to gain the situation of surgery qualifications, progression-free survival and overall survival, so as to evaluate the survival prognosis, then whether patients benefit and what kind of patients benefit most from TKI monotherapy treatment or its combination are explored.ResultsThe median progression-free survival of involved 81 patients was 13.87 months (95% confidence interval (CI): 11.66–16.08), and the median survival was 41.47 months (95%CI: 20.11–62.83). The 5-year survival rates were 91.0, 80.3, 56.1, 45.5, and 32.5%, respectively. After first-line TKI therapy, seven patients (8.6%) were reevaluated as eligible for surgery and proceeded to surgery. Although no characteristics were found to be statistical prognostic, younger female non-smokers still tended to have a better prognosis with longer progression free survival and overall survival.ConclusionsTKIs are a viable option for mutant stage III unresectable NSCLC patients who have achieved good clinical benefit from TKI. Patients who cannot tolerate chemoradiotherapy, especially those with driver gene mutations, can choose targeted therapy for first-line treatment.

Highlights

Lung cancer is currently one of the most malignant tumors, while five-year survival at all stages was about 19%
At the follow-up end point, we found that 23 patients (28.4%) had tumor progression and metastasis development to stage IV, with eight patients presenting with brain metastases, seven patients with bone metastases, five patients with pleural metastases or malignant pleural fluid, five patients with both lungs, one patient with liver, and one patient with abdominal cavity
69 patients (85.2%) had EGFR mutations, and we explored the difference in survival prognosis of 28 patients (34.6%) with classic 19 deletion, compared with 17 patients (21%) with 21 mutations

Summary

Introduction

Lung cancer is currently one of the most malignant tumors, while five-year survival at all stages was about 19%. While the 5-year overall survival rate of standard concurrent chemoradiotherapy wandered around 20% [7], the long-term prognosis were 15–35% for unresectable or inoperable stage IIIA and 5–10% for stage IIIB [8]. Further studies are still needed that whether patients with driver gene mutation can benefit from first-line treatment with EGFR TKIs. For unresectable stage III non-small cell lung cancer (NSCLC), concurrent chemoradiotherapy is nowadays the standard treatment. Patients with advanced NSCLC harboring driver-gene mutations benefit from Tyrosine Kinase Inhibitors (TKIs) Therapy. In a real-world setting, there is room for exploring the benefit of TKIs in stage III unresectable NSCLC patients with mutation

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