Overall survival in advanced NSCLC increased with less toxic chemotherapy

A 10-year population-based study shows that increased availability of better systemic chemotherapies and targeted therapies for patients with advanced non-small cell lung cancer (NSCLC) coincides with increased usage of these therapies. This in turn leads to a significant increase in overall survival.

Researchers from the British Columbia Cancer Agency, Vancouver, Canada, performed a retrospective chart review of all patients referred to the agency with advanced stage (IIIB or IV) lung cancer and grouped the patients into four 1-year time frame cohorts; one termed “baseline” and three other groups that each started 6-months after a new second-line agent (docetaxel, erlotinib, and pemetrexed) was made commercially available and put into practice.

In British Columbia, Canada, the implementation of the second-line agents docetaxel, erlotinib, and pemetrexed occurred in December 2000, October 2005, and June 2007, respectively. Cohort 1 (January to December 1998) with 555 patients was the baseline, cohort 2 (May 2001-April 2002) had 613 patients, cohort 3 (March 2006-February 2007) had 688 patients, and cohort 4 (November 2007-Ocotober 2008) had 750 patients.

The results, published in the Journal of Thoracic Oncology (2014; doi:10.1097/JTO.0000000000000225), show that the usage of second-line therapy increased significantly over time. At baseline only 21% of the patients received second-line therapy but in Cohorts 2 and 3 this increased to 27% and 37% respectively, and by Cohort 4 more than half (55%) received second-line therapy. The most common agent in Cohort 1 was docetaxel (48%) but by Cohort 4 erlotinib (EGFR TKIs) and pemetrexed were used 50% and 26% of the time, respectively.

The research also found that the proportion of patients who received at least first-line systemic chemotherapy also increased over the four time points from 16% in Cohort 1 to 23%, 34%, and 33% for Cohorts 2, 3, and 4, respectively.

The median overall survival of the patients who did not receive any chemotherapy did not change over the four time points; 3.9, 4.0, 3.1, and 3.2 months (P=.136). However, for those that did receive chemotherapy, survival increased significantly: 9.4, 9.8, 11.0, and 11.8 months (P=.023). Examination of the entire population showed that the median overall survival of those not receiving chemotherapy was 3.51 months, whereas for those receiving first-line therapy it was 7.9 months and for those receiving second-line therapy or beyond the survival was 17 months (P<.001).

“The benefits of chemotherapy and specifically second-line treatment on patient outcomes are substantial, even in a widely mixed population of patients, which confirms the advances seen in clinical trial populations over the past decade,” noted the authors. Likewise, “As the options for treatment of NSCLC expand we anticipate that the outlook for lung cancer will continue to improve.”

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