National, Observational, Multicentric Retrospective Study to Understand Treatment Patterns, Patient Journey and Characteristics with Stage III Non-Small Cell Lung Cancer Patients in Turkey: Stone Trial

Abstract

In this multi-institutional study, we sought to investigate the contemporary treatment patterns of patients at initial and during first and second progression diagnosed with primary stage III NSCLC in Turkey. The patient characteristics, disease burden, treatment patterns and patient journey of stage III NSCLC patients were revealed. The clinical data of 492 patients treated between 2013 and 2017 were collected from geographically diverse set of ten community oncology centers in Turkey. The initial treatment included all treatment facilities after diagnosis. It includes chemotherapy (ChT) and radiotherapy (RT) delivered either sequentially or concurrently. These treatment patterns are analyzed at first treatment period, and during first and second progression periods. Median age was 64 years (range, 40 – 90 years). Most of the patients were male (434 patients, 88.2%) and were either past smoker or current smoker (462 patients, 93.9%). More than half of the patients (56.1%) had squamous cell carcinoma (SCC) and mean tumor size was 5.1±2.1 cm. According to the American Joint Committee on Cancer (AJCC) staging system 7th edition clinical stage IIIA (311 patients, 63.2%) was more frequently seen, and stage IIIB (278 patients, 56.5%) was most frequent when patients were staged according to AJCC 8th edition. For initial treatment 429 patients (89.2%) received ChT and RT, either concurrently (393 patients, 79.9%) or sequentially (46 patients, 9.3%), and only 53 patients (10.8%) were treated with RT only. Most frequently used RT technique was 3-dimensional conformal RT (3DCRT) (276 patients, 56.0%), while only 3 patients (0.6%) were treated with stereotactic radiotherapy (SBRT). Median 9.3 months after completion of initial treatment 288 patients (58.4%) had disease progression, and 166 patients (64.6%) received treatment). The main treatment modality at first progression was systemic treatment (121 patients, 72.9%), while 65 patients (37.1%) were treated with RT only. The RT treatment sites were mostly to the metastatic sites. The SBRT technique was used in 25 patients (22.2%). Disease progression was observed in 30 patients median 4.2 months (range, 0.8 – 11.4 months) after completion of treatment of first progression. Of these patients 20 patients (66.7%) received systemic therapy. The use of TKI and immunotherapeutic agent was quite limited in this cohort during initial treatment, first and second progression time. In the initial treatment period, none of the patients received TKI and immunotherapy. Only 7 patients (5.8%) received TKI and 3 patients (2.5%) had immunotherapeutics during first progression interval. At second progression only 2 patients (1%) received TKI and immunotherapy separately. This national observational study showed that the majority of patients with unresectable stage III NSCLC received cCRT as the first therapy, and this practice was consistent with guidelines.