Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 1;6(3):e232002.
doi: 10.1001/jamanetworkopen.2023.2002.

Trends in Survival Rates of Non-Small Cell Lung Cancer With Use of Molecular Testing and Targeted Therapy in Korea, 2010-2020

Sang Ah Chi  1 , Hyeyeon Yu  2 , Yoon-La Choi  3 , Sehhoon Park  2 , Jong-Mu Sun  2 , Se-Hoon Lee  2 , Jin Seok Ahn  2 , Myung-Ju Ahn  2 , Dae-Ho Choi  2 , Kyunga Kim  4   5   6 , Hyun Ae Jung  2 , Keunchil Park  2
Affiliations

Trends in Survival Rates of Non-Small Cell Lung Cancer With Use of Molecular Testing and Targeted Therapy in Korea, 2010-2020

Sang Ah Chi et al. JAMA Netw Open. .

Abstract

Importance: Over the past 10 years, treatment of non-small cell lung cancer (NSCLC) has been continually revolutionized. However, standard clinical trials may not reflect current multiple lines of treatment and corresponding outcomes in a timely manner.

Objective: To investigate outcomes associated with new treatment of NSCLC in a clinical setting.

Design, setting, and participants: This cohort study included patients with NSCLC between January 1, 2010, and November 30, 2020, who received any anticancer treatment at Samsung Medical Center in Korea. Data were analyzed from November 2021 through February 2022.

Exposures: Clinical and pathological stage, histology, and major druggable sequence variation, including epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), ROS1, RET, MET exon 14 skipping, BRAF V600E, KRAS G12C, and NTRK between 2 periods (period I: 2010-2015 vs period II: 2016-2020).

Main outcomes and measures: The primary outcome was the 3-year survival rate of NSCLC. Secondary outcomes included median overall survival, progression-free survival, and recurrence-free survival.

Results: Among 21 978 patients with NSCLC (median [range] age at diagnosis, 64.1 [57.0-71.0] years; 13 624 males [62.0%]), there were 10 110 patients in period I and 11 868 patients in period II; adenocarcinoma (AD) was the predominant histology (7112 patients [70.3%] in period I and 8813 patients [74.3%] in period II). There were 4224 never smokers [41.8%] in period I and 5292 never smokers [44.6%] in period II. Compared with patients in period I, patients during period II were more likely to undergo molecular tests in the AD (5678 patients [79.8%] vs 8631 patients [97.9%]) and non-AD (1612 of 2998 patients [53.8%] and 2719 of 3055 patients [89.0%]) groups. In patients with AD in period I, 3-year survival rates were 92.8% (95% CI, 91.8%-93.7%), 72.4% (95% CI, 68.3%-76.8%), 56.7% (95% CI, 53.4%-60.2%), and 28.7% (95% CI, 27.0%-30.4%) for stage I, II, III, and IV, respectively. In period II, 3-year survival rates of patients with AD were 95.1% (95% CI, 94.4%-95.9%), 82.5% (95% CI, 79.1%-86.1%), 65.1% (95% CI, 61.8%-68.6%), and 42.4% (95% CI, 40.3%-44.7%) for each stage, respectively. In patients without AD, 3-year survival rates were 72.0% (95% CI, 68.8%-75.3%), 60.0% (95% CI, 56.2%-64.1%), 38.9% (95% CI, 35.6%-42.5%), and 9.7% (95% CI, 7.9%-12.1%) for each stage in period I. In period II, the 3-year survival rates of patients without AD were 79.3% (95% CI, 76.3%-82.4%), 67.3% (95% CI, 62.8%-72.1%), 48.2% (95% CI, 44.5%-52.3%), and 18.1% (95% CI, 15.1%-21.6%) for each stage.

Conclusions and relevance: In this cohort study of 10 years of clinical data, survival outcomes were improved across all stages, with larger increases in patients with stage III to IV disease. The incidence of never-smokers and the use of molecular testing increased.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Lee reported receiving grants from Merck outside the submitted work. Dr J. Ahn reported receiving personal fees from Roche Korea, Menarini Korea, Pfizer, Boehringer Ingelheim, Kyowa Kirin, Amgen Korea, Yuhan, AstraZeneca Korea, Bayer Korea, Takeda Phar, Novartis Korea, Hanmi, BC World, Immuneoncia, Pharmbio Korea, Yooyoung, Vifor Pharma, and Bixink outside the submitted work. Dr K. Park reported receiving a patent licensed to Keunchil Park and Hyun Ae Jung, patent No. 10-22272401. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Molecular Profiling by Histology and Period
Patients with any major druggable sequence variation included those with epidermal growth factor receptor (EGFR) variation, anaplastic lymphoma kinase (ALK) rearrangement, ROS1 rearrangement, RET rearrangement, BRAF V600E variation, MET exon 14 skipping, KRAS G12C variation, or NTRK 1/2/3 gene fusion. Patients without any major druggable variation included those with emerging druggable variations (NRAS, HRAS, human epidermal growth factor receptor 2 [ERBB2], PIK3CA, FGFR, RAF1, and TSC), no driver variations, or EGFR and ALK wild type or those who did not undergo molecular tests. For AD groups, subtypes of EGFR positive are additionally illustrated. NGS indicates next-generation sequencing; PD-L1, programmed death-ligand 1.
Figure 2.
Figure 2.. Overall Survival Curves For Patients With Druggable Variations and Adenocarcinoma (AD)
A, Survival curves for patients with epidermal growth factor receptor (EGFR) variation are presented. B, Survival curves for patients with anaplastic lymphoma kinase (ALK) variation are presented.
Figure 3.
Figure 3.. Overall Survival Curves for Patients With Adenocarcinoma (AD) and Without Druggable Variations
Figure 4.
Figure 4.. Overall Survival Curves for Patients Without Adenocarcinoma (AD) and With and Without Druggable Variations
See this image and copyright information in PMC

References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi:10.3322/caac.21492 - DOI - PubMed
    1. Jung KW, Won YJ, Hong S, Kong HJ, Lee ES. Prediction of cancer incidence and mortality in Korea, 2020. Cancer Res Treat. 2020;52(2):351-358. doi:10.4143/crt.2020.203 - DOI - PMC - PubMed
    1. Scagliotti GV, Parikh P, von Pawel J, et al. . Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol. 2008;26(21):3543-3551. doi:10.1200/JCO.2007.15.0375 - DOI - PubMed
    1. Lynch TJ, Bell DW, Sordella R, et al. . Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med. 2004;350(21):2129-2139. doi:10.1056/NEJMoa040938 - DOI - PubMed
    1. Jänne PA, Yang JC, Kim DW, et al. . AZD9291 in EGFR inhibitor-resistant non-small-cell lung cancer. N Engl J Med. 2015;372(18):1689-1699. doi:10.1056/NEJMoa1411817 - DOI - PubMed

Publication types

Substances