CHARACTERISTICS AND TREATMENT OUTCOMES OF METASTATIC NON-SMALL CELL LUNG CANCER IN NORTHEAST OHIO: A COMMUNITY PRACTICE EXPERIENCE

Abstract

TOPIC: Lung Cancer TYPE: Original Investigations PURPOSE: Lung cancer is the leading cause of cancer related death in Ohio in 2019. As per “State of Lung Cancer report”, Ohio’s five-year lung cancer survival rate is 20% (below the national average of 21.7%). It is reported that 55% of patients with non–small cell lung cancer (NSCLC) present with metastatic disease (mNSCLC). Despite the introduction of checkpoint inhibitors, survival benefit remains variable. In Northeast Ohio, occupational exposure to asbestos at steel mills has been well recognized. The contributory effect of an asbestos exposure on survival in mNSCLC is unknown. The objective of this study is to investigate the outcome of mNSCLC in the Northeast Ohio population. METHODS: Retrospective study was conducted using data collected from a community-based cancer care practice in Northeast Ohio. Patients with mNSCLC diagnosed from January 2016, through December 2019 were identified. Patients were included if they had stage IV NSCLC at diagnosis, performance status 0-3, received chemotherapy/ targeted therapy or immune checkpoint inhibitors (ICIs). Patients younger than 18 years, diagnosed with more than one malignancy, on renal dialysis or missing information on tumor characteristics or follow-up were excluded from study.Patient characteristics, EGFR/ALK gene mutation status, metastatic locations, and response to treatment were studied. Overall survival in patients who received chemotherapy was compared to patients receiving chemotherapy plus ICIs or targeted therapy using cox proportional hazard model. RESULTS: A total of 61 patients met inclusion criteria. The median age of the patient cohort was 64.3 years with 60.6% of patients being male. Former or current smokers constituted 91% of the subjects. Multiple metastases at time of diagnosis were recognized in 22 patients (36%) of patients. Nine patients (14.7%) were EGFR mutation or ALK rearrangement positive. Of 61 mNSCLC patients, 33 (54%) received chemotherapy only while 28 (46%) received additional ICIs. Patients who underwent ≥ 2 lines of treatment were 26.2%. Surprisingly, one-year and three-year overall survival (OS) rates were greater in patients who received chemotherapy +/- targeted therapy compared to chemotherapy plus ICIs therapy combinations. OS was 10.0 months in the chemotherapy plus checkpoint inhibitor group vs 17.0 months in the chemotherapy/ targeted therapy group (P value <0.04). Asbestos exposure was not associated with statistically significant impact on OS (P value 0.7). Patients with EGFR mutation/ALK rearrangement status and those with single metastases at time of presentation had better survival at 1 and 3 years (p value 0.02 each). CONCLUSIONS: Patients with single metastasis at the time of presentation had better OS. There was no statistical significance of asbestos exposure on OS. Targeted therapy improved OS in mNSCLC patients with gene mutations. ICIs were most often used as second- or third-line treatment, which might explain lower survival in the immunotherapy plus chemotherapy group. CLINICAL IMPLICATIONS: This study within its limits suggests that survival benefit of ICIs on OS in real-world patients may be different than in clinical trial cohorts. This difference might be explained by different trial eligibility criteria, population biologics, and environmental differences. DISCLOSURES: No relevant relationships by Gary Gibson, source=Web Response, value=I honestly don't know Removed 04/30/2021 by Gary Gibson, source=Web Response No relevant relationships by Lori Hemrock, source=Web Response No relevant relationships by Hamid Ismail, source=Web Response No relevant relationships by Parth Shah, source=Web Response No relevant relationships by Noha Soror, source=Web Response