Efficacy and safety of taxane versus gemcitabine for advanced stage lung squamous cell carcinoma in global EHR-based retrospective cohorts: A pairwise propensity score-matched comparison

Abstract

Background: Lung squamous cell carcinoma represents a significant global health challenge, with platinum-based chemotherapy regimens remaining a cornerstone of treatment. While both Taxanes and Gemcitabine are recommended as category 1 treatment options by the National Comprehensive Cancer Network (NCCN), their comparative effectiveness in real-world settings requires further investigation.

Methods: This retrospective cohort study utilized the TriNetX global collaborative network to analyze data between January 1, 1990, and October 31, 2024. Adults with stage IV lung squamous cell carcinoma were identified using ICD-10 code C34 and the TriNetX oncology disease classification system. Patients were categorized into Taxane and Gemcitabine groups. Propensity score matching was employed to minimize selection bias. Primary and secondary outcomes included overall survival, progression-free survival, and adverse events.

Results: A total of 992 patients were included, with 203 patients in each group after propensity score matching. The Taxane group demonstrated significantly improved overall survival compared to the Gemcitabine group (HR: 0.638, 95 % CI: 0.497-0.0821, p = 0.0004). Progression-free survival also showed statistically significant benefit over the Taxane group (HR: 0.686, 95 % CI: 0.532-0.885, p = 0.0035). Pairwise analysis revealed that Paclitaxel demonstrated superiority compared to both Docetaxel and Gemcitabine. The incidence of adverse events was comparable between groups.

Conclusions: Our findings demonstrate that Taxane, particularly Paclitaxel, offers superiority compared to Gemcitabine in patients with advanced lung squamous cell carcinoma, with comparable safety profile. These results support the prioritization of Taxane-based regimens in clinical practice. Future research should focus on combination strategies with immunotherapy to enhance treatment outcomes.

Keywords: Chemotherapy; Gemcitabine; Lung cancer; Lung squamous cell carcinoma; Taxane.