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. 2022 Mar 25;22(1):323.
doi: 10.1186/s12885-022-09421-7.

Survival past five years with advanced, EGFR-mutated or ALK-rearranged non-small cell lung cancer-is there a "tail plateau" in the survival curve of these patients?

Shoko Sonobe Shimamura  1 , Takehito Shukuya  2 , Tetsuhiko Asao  1 , Daisuke Hayakawa  1 , Kana Kurokawa  1 , Shiting Xu  1 , Keita Miura  1 , Yoichiro Mitsuishi  1 , Ken Tajima  1 , Rina Shibayama  1 , Naoko Shimada  1 , Fumiyuki Takahashi  1 , Kazuhisa Takahashi  1
Affiliations

Survival past five years with advanced, EGFR-mutated or ALK-rearranged non-small cell lung cancer-is there a "tail plateau" in the survival curve of these patients?

Shoko Sonobe Shimamura et al. BMC Cancer. .

Abstract

Background: The prognosis of patients with NSCLC harboring oncogenic driver gene alterations, such as EGFR gene mutations or ALK fusion, has improved dramatically with the advent of corresponding molecularly targeted drugs. As patients were followed up for about five years in most clinical trials, the long-term outcomes beyond 5 years are unclear. The objectives of this study are to explore the clinical course beyond five years of chemotherapy initiation and to investigate factors that lead to long-term survival.

Methods: One hundred and seventy-seven patients with advanced, EGFR-mutated or ALK-rearranged NSCLC who received their first chemotherapy between December 2008 and September 2015 were included. Kaplan Meier curves were drawn for the total cohort and according to subgroups of patients' characteristics.

Results: Median OS in the total cohort was 40.6 months, the one-year survival rate was 89%, the three-year survival rate was 54%, and the five-year survival rate was 28%. Median OS was 36.9 months in EGFR-mutated patients and 55.4 months in ALK-rearranged patients. The OS curve seemed to plateau after 72 months, and most of the patients who were still alive after more than five years are on treatment. Female sex, age under 75 years, an ECOG PS of 0 to 1, ALK rearrangement, postoperative recurrence, and presence of brain metastasis were significantly associated with longer OS.

Conclusions: A tail plateau was found in the survival curves of patients with advanced, EGFR-mutated and ALK-rearranged NSCLC, but most were on treatment, especially with EGFR-mutated NSCLC.

Keywords: ALK rearrangement; EGFR mutation; Long survival; NSCLC.

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Conflict of interest statement

The authors have no conflicts of interest directly relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves of OS Survival data in the total study population
Fig. 2
Fig. 2
Swimmer plot of EGFR-mutated 5 years or more patients. 1–37 designates each patient. Blue indicates EGFR-TKI; red, cytotoxic chemotherapy; green, immunotherapy; and gray signals no treatment.
Fig. 3
Fig. 3
Swimmer plot of ALK-rearranged 5 years or more patients. 1–9 designates each patient. Blue indicates ALK-TKI; red, cytotoxic chemotherapy; and gray signals no treatment.
See this image and copyright information in PMC

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