P09.04 Changing Survival and Treatment Patterns in Patients with Stage IV Non-Small Cell Lung Cancer (NSCLC) in Alberta, Canada

Abstract

We have previously reported that rapid physical decline and poor performance status means that only a minority of patient with metastatic NSCLC receive systemic treatment. Over the last decade, treatment advances in the form of maintenance chemotherapy, targeted therapies and immunotherapy for advanced disease have shown benefit in randomized phase III trials and been adopted as standard of care. Nevertheless, there are conflicting reports of trends in overall survival. We therefore looked at real-world patterns of treatment and survival in a cohort of patients with metastatic NSCLC. We performed a retrospective analysis of a cohort of 4400 patients diagnosed with de novo stage IV NSCLC in Alberta, Canada between 2011-2016 using the Glans-Look database. Data was derived from the provincial cancer registry and supplemented with additional chart review for a subset of cases. Univariate survival analysis used the Log-Rank method, and multivariate analysis Cox Regression. All other tests were Chi-Squared. Median survival in months is shown with 95% confidence intervals. The number of patients included for specific tests is indicated in cases where there was missing data. There was a trend towards improving overall survival over the study period (4.67 (4.24 – 5.10) months in 2011, and 5.90 (5.22 – 6.58) months in 2016; univariate P = 0.092). We observed an increasing proportion of patients with no smoking history (N = 1257; 11.2% in 2011 vs 31.6% in 2016; P < 0.001), an increasing proportion of patients receiving systemic therapy (29.1% in 2011 vs 38.0% in 2016; P < 0.001), and an increasing proportion of patients treated with systemic therapy that received 1st line targeted therapy (N = 541; 20.3% in 2011 vs 39.1% in 2016; P < 0.001). These factors were also associated with improved overall survival in univariate analysis: never smoker vs ever smoker (N = 541; 17.47 (14.61 – 20.33) months vs 6.33 (5.47 – 7.19) months; P < 0.001); receipt of systemic therapy (12.00 (11.30 – 12.70) months vs 3.10 (2.94 – 3.26) months; P < 0.001) targeted therapy vs chemotherapy (N = 541 ; 19.30 (16.06 – 22.54) months vs 15.98 (14.37 – 17.56) months; P = 0.015). Younger age at diagnosis, female gender, receiving systemic therapy, and use of 1st line targeted therapy vs chemotherapy were all significantly associated with improved survival in multivariate models (smoking status excluded from analysis due to number of cases with missing data). We observed a trend towards improving survival from 2011 to 2016 in patient with stage IV NSCLC in Alberta, Canada. While we cannot account for all potentially relevant changes to the management of NSCLC over that time, we observed increasing rates of systemic therapy administration and use of 1st line targeted therapy, which may be in part responsible for improving survival.