Survival Gains from First-Line Systemic Therapy in Metastatic Non-Small Cell Lung Cancer in the U.S., 1990-2015: Progress and Opportunities

Abstract

Background: Approximately 190,000 Americans are diagnosed with non-small cell lung cancer (NSCLC) annually, and about half have metastatic (Stage IV) disease. These patients have historically had poor survival prognosis, but several new therapies introduced since 2000 provide options for improved outcomes. The objectives of this study were to quantify survival gains from 1990, when best supportive care (BSC) only was standard, to 2015 and to estimate the impact of expanded use of systemic therapies in clinically appropriate patients.

Materials and methods: We developed a simulation model to estimate survival gains for patients with metastatic NSCLC from 1990-2015. Survival estimates were derived from major clinical trials and extrapolated to a lifetime horizon. Proportions of patients receiving available therapies were derived from the Surveillance, Epidemiology, and End Results database and a commercial treatment registry. We also estimated gains in overall survival (OS) in scenarios in which systemic therapy use increased by 10% and 30% relative to current use.

Results: From 1990-2015, one-year survival proportion increased by 14.1% and mean per-patient survival improved by 4.2 months (32,700 population life years). Increasing treated patients by 10% or 30% increased OS by 5.1 months (39,700 population life years) and 6.9 months (53,800 population life years), respectively.

Conclusion: Although survival remains poor in metastatic NSCLC relative to other common cancers, meaningful progress in per-patient and population-level outcomes has been realized over the past 25 years. These advances can be improved even further by increasing use of systemic therapies in the substantial proportion of patients who are suitable for treatment yet who currently receive BSC only. The Oncologist 2017;22:304-310 IMPLICATIONS FOR PRACTICE: Approximately 93,500 Americans are diagnosed with metastatic non-small cell lung cancer (NSCLC) annually. Historically, these patients have had poor survival prognosis, but newer therapies provide options for improved outcomes. This simulation modeling study quantified metastatic NSCLC survival gains from 1990-2015. Over this period, the one-year survival proportion and mean per-patient survival increased by 14.1% and 4.2 months, respectively. Though metastatic NSCLC survival remains poor, the past 25 years have brought meaningful gains. Additional gains could be realized by increasing systemic therapy use in the substantial proportion of patients who are suitable for treatment, yet currently receive only supportive care.

Keywords: Non‐small cell lung cancer; Overall survival; Systemic therapy.

Figure 1.

Cumulative mean overall survival gain (versus 1990) by analysis year and introduction of new first‐line systemic therapies. The new systemic therapy options in the given analysis year are listed above each bar. Of the 4.2‐month mean overall survival improvement achieved from 1990 to 2015, 1.9 months (45%) is estimated to be attributable to U.S. Food and Drug Administration approvals of targeted therapies in the past 10 years. Abbreviations: ALK, anaplastic lymphoma kinase; EGFR, epidermal growth factor receptor

Figure 2.

Metastatic non‐small cell lung cancer estimated overall survival by year of diagnosis, 2015 versus 1990. When the proportion of patients receiving systemic therapy in 2015 was increased by 10% (Scenario 1) or 30% (Scenario 2), the improvement in survival relative to 1990 increased by 5.1 months (39,700 population life years) and 6.9 months (53,800 population life years), respectively. Abbreviations: NSCLC, non‐small cell lung cancer.