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Multicenter Study
. 2011;16(9):1307-15.
doi: 10.1634/theoncologist.2011-0079. Epub 2011 Aug 11.

Impact of new chemotherapeutic and targeted agents on survival in stage IV non-small cell lung cancer

Joanne L Yu  1 , Christine Simmons, J Charles Victor, Dolly Han, Sophie Hogeveen, Natasha Leighl, Sunil Verma
Affiliations
Multicenter Study

Impact of new chemotherapeutic and targeted agents on survival in stage IV non-small cell lung cancer

Joanne L Yu et al. Oncologist. 2011.

Abstract

Purpose: Significant advances in the systemic management of metastatic non-small cell lung cancer (NSCLC) have occurred over the past decade, with options now including multiple lines of chemotherapy, epidermal growth factor receptor inhibitors, and antiangiogenic agents. Improvements in overall survival have been demonstrated in randomized controlled trials comparing these newer agents with best supportive care or standard therapy. This study examined uptake of these therapies in general practice and their impact on survival.

Methods: This retrospective cohort study compared demographic, treatment, and survival data among 987 patients diagnosed with stage IV NSCLC at two institutions in 1998, 2003, and 2008. Cohorts were selected based on intervals when doublet chemotherapy, second-line chemotherapy, and targeted agents were incorporated into the standard treatment regimen.

Results: The proportion of patients receiving systemic therapy increased over time (20% in 1998, 42% in 2008). Overall survival improved significantly across cohorts (p < .001), with 2-year survival rates of 0.3% in 1998, 4% in 2003, and 15% in 2008. In a multivariate survival analysis, the 2003 and 2008 cohorts were independently associated with longer survival, as was the use of one or more lines of systemic therapy. Elderly patients (aged ≥70 years) were also more likely to receive systemic therapy over time, with longer overall survival (p < .001).

Conclusion: Over the past decade, there has been an increasing use of systemic therapy in stage IV NSCLC patients, including the elderly. This has been associated with significantly longer overall survival.

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Conflict of interest statement

Disclosures: Joanne L. Yu: None; Christine Simmons: None; J. Charles Victor: None; Dolly Han: None; Sophie Hogeveen: None; Natasha Leighl: None; Sunil Verma: Consultant/advisory role: Eli Lilly, Roche, AstraZeneca; Research funding/contracted research: Roche.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors or independent peer reviewers.

Figures

Figure 1.
Figure 1.
Overall survival in stage IV NSCLC. (A): The overall survival time of patients improved across cohorts (p < .001). (B, C): Overall survival time of patients who received systemic therapy versus best supportive care in the 1998 cohort (B) and the 2008 cohort (C). The survival advantage associated with systemic therapy increased across cohorts (p = .002).
Figure 2.
Figure 2.
Use of systemic therapy and survival in the elderly. (A): An increase in the use of systemic therapy over time occurred in both the younger (age <70 years) and elderly (age ≥70 years) subgroups of patients with stage IV NSCLC. (B) Overall survival of elderly patients diagnosed with stage IV NSCLC in 1998, 2003, and 2008. Abbreviation: NSCLC, non-small cell lung cancer.
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