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. 2022 Jan;11(1):86-93.
doi: 10.1002/cam4.4427. Epub 2021 Nov 16.

Effect of targeted therapy and immunotherapy on advanced nonsmall-cell lung cancer outcomes in the real world

Aria Shokoohi  1 , Zamzam Al-Hashami  1   2 , Sara Moore  3 , Alexandra Pender  1   2 , Selina K Wong  1   2 , Ying Wang  1   2 , Bonnie Leung  1 , Jonn Wu  2   4 , Cheryl Ho  1   2
Affiliations

Effect of targeted therapy and immunotherapy on advanced nonsmall-cell lung cancer outcomes in the real world

Aria Shokoohi et al. Cancer Med. 2022 Jan.

Abstract

The evolution of diagnosis and treatment of advanced nonsmall-cell lung cancer (NSCLC) has led to increasing the use of targeted therapy and immune checkpoint inhibitors. The study goal was to assess the effect of molecular testing and the introduction of new therapies on overall survival (OS). All patients with stage IV NSCLC referred to BC Cancer were included in the study. Four 1-year time cohorts were created based on molecular testing implementation and funded drug availability: C1 baseline (2009), C2 EGFR TKI access (2011), C3 ALK inhibitor access (2015), C4 immunotherapy availability (2017). Baseline demographics, disease characteristics, and systemic therapy details were collected retrospectively. OS was calculated using the Kaplan-Meier method and compared using the log-rank test. There were 3421 patients identified with stage IV NSCLC and 1319 (39%) received systemic therapy. In the four 1-year time cohorts C1/C2/C3/C4: driver mutation-targeted treatment increased 1/17/27/34% (of total systemic therapy), as did treatment with any line immunotherapy <1/1/9/38%. Median OS with best supportive care (BSC) was 3.4/3.1/3.2/2.9 m (p = 0.16) and with systemic treatment 9.9/10.9/13.9/15.0 m (p < 0.001). Median OS by treatment exposure was BSC 3.1 m, chemotherapy only 7.3 m, targeted therapy 17.5 m, and immunotherapy 20.7 m. In our real-world study, following the introduction of targeted therapy and immune checkpoint inhibitors, there was a significant improvement in OS in each successive time cohort concordant with advancements in therapeutic options.

Keywords: chemotherapy; immunotherapy; medical oncology; nonsmall-cell lung cancer; targeted therapy.

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Conflict of interest statement

Dr. Pender reports receiving personal fees from Guardant Health and Bristol Myers Squibb, outside the submitted work; Ms. Leung reports receiving personal fees from Takeda Canada, outside the submitted work; and Dr. Ho reports receiving grants and personal fees from AstraZeneca, EMD Serono, and Roche, and personal fees from Bayer, Bristol Myers Squibb, Eisai, Merck, Novartis, and Takeda Canada, all outside of the submitted work. The remaining authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Overall survival (OS) by year for patients diagnosed with stage IV nonsmall‐cell lung cancer receiving (A) best supportive care and (B) treatment with systemic therapy
FIGURE 2
FIGURE 2
Overall survival (OS) of the whole study population by treatment exposure for patients diagnosed with stage IV nonsmall‐cell lung cancer
See this image and copyright information in PMC

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