Targeted therapy superior to chemotherapy, best supportive care at improving survival in NSCLC

Survival benefit in patients with de novo stage IV nonsmall-cell lung cancer (NSCLC) depends on the type of treatment received, with significantly better median overall survival (OS) seen with the use of small-molecule targeted therapy against epidermal growth factor receptor mutations and anaplastic lymphoma kinase rearrangements than with best supportive care, reports a study.

The investigators identified patients diagnosed with de novo stage IV NSCLC from 1 April 2010 to 31 March 2015 and obtained data for baseline characteristics, treatment, and outcomes from provincial data sources, including the cancer registry and electronic medical records.

Systemic treatments were classified as chemotherapy, targeted therapy (antiepidermal growth factor receptor and antianaplastic lymphoma kinase), and immunotherapy (checkpoint inhibitors); clinical outcomes were characterized by treatment type.

Of the 6,438 patients identified with NSCLC, 3,606 (56 percent) had de novo stage IV disease (median age at diagnosis 69 years, 52.4 percent men). First-line palliative treatment were as follows: chemotherapy (n=703, 19.5 percent), targeted agents (n=204, 5.7 percent), immunotherapy (n=1, 1 percent), radiotherapy (n=246, 6.8 percent), and best supportive care (n=2,698, 74.8 percent).

Median OS from diagnosis was 3.8 months for the entire cohort. Within subgroups, median OS was 18.0 months for targeted therapies, 9.4 months for chemotherapy, and 2.5 months for best supportive care. Only 34 patients (91.0 percent) received immunotherapy at any line.

“Treatment strategies for metastatic NSCLC are evolving rapidly and can be highly variable,” the investigators said. “Real-world evidence of treatment patterns and outcomes can provide an understanding of our current practice and offer insights on ways to incorporate emerging therapies into our treatment paradigm.”