Long-Term Survival of Patients with Metastatic Non-Small-Cell Lung Cancer over Five Decades.

Jair Bar,Tamar Beller,Amir Onn,Yaacov Lawrence,Ofer Margalit,Uri Amit,Teodor Kuznetsov,Sarit Appel,Damien Urban,Xiaosheng Wang

doi:10.1155/2021/7836264

Abstract

Objective Novel therapeutics and supportive care improved outcomes for metastatic non-small-cell lung cancer (mNSCLC) patients. Major advances over the past five decades include the introduction of combination chemotherapy, small molecules targeting mutant proteins, especially EGFR, and more recently immunotherapy. We aim to document real-world long-term survival over the past five decades. Methods Survival statistics were extracted from the Survival, Epidemiology, and End Results (SEER) database for mNSCLC patients during 1973–2015. Two- and five-year survival (2yS and 5yS) were analyzed using Kaplan–Meier and proportional hazard models. Results The study population consisted of 280,655mNSCLC patients diagnosed during 1973–2015. Longer survival was seen in younger, female, married, Asian/Pacific Islander race, adenocarcinoma, lower grade, more recent diagnosis, higher income, and chemotherapy-treated patients. 2yS increased during the study period from 2.6% to 12.9%, and 5yS increased from 0.7% to 3.2%. 2yS of patients <50 years of age rose from 2.1% to 22.8%, and their 5yS rose from 0.7% to 6.2%. 2yS of adenocarcinoma patients improved from 2.7% to 16.2%, and their improved 5yS from 1.1% to 3.9%. Conclusions Between 1973 and 2015, there was a dramatic improvement in long-term survival, with an approximately five-fold increase in both 2yS and 5yS. Nonetheless, absolute numbers of long-term survivors remained low, with less than 4% living 5 years. This provides a baseline to compare long-term outcomes seen in the current generation of clinical trials.

Highlights

Lung cancer is the number one cause of cancer-related death worldwide, inflicting about 1.6 million deaths annually [1]
In 2016, 158,080 lung cancer patients died in the USA alone [2].Lung cancer patients are diagnosed as metastatic disease in 40–50% of the cases [3, 4], with a median survival of less than nine months [3, 5]. e most common type of lung cancer is non-small-cell lung cancer (NSCLC), comprising 85–89% of lung cancers
Significant advances in the care of metastatic NSCLC patients over the recent decades include the advent of palliative chemotherapy [5], histology-directed chemotherapy agents [6], improvements in supportive care [7], more recently targeted agents [8], and immunotherapy [9]

Summary

Introduction

Lung cancer is the number one cause of cancer-related death worldwide, inflicting about 1.6 million deaths annually [1]. Significant advances in the care of metastatic NSCLC (mNSCLC) patients over the recent decades include the advent of palliative chemotherapy [5], histology-directed chemotherapy agents [6], improvements in supportive care [7], more recently targeted agents [8], and immunotherapy [9]. Modern treatments have achieved long-term survival, for instance, EGFR-mutant metastatic lung adenocarcinoma treated with erlotinib or gefitinib has a 14.6% five-year survival, and immunotherapy has achieved 13.4% five-year survival amongst patients with mixed levels of programmed death ligand-1 (PD-L1) expression [10]. Metastatic anaplastic lymphoma kinase(ALK-) positive NSCLC patients were reported to have a median overall survival (mOS) of around 4–5 years [11]. Long-term survival of mNSCLC is rarely reported in studies and is not the focus of most retrospective database analyses

Results

Discussion

Conclusion