First-line therapies for advanced NSCLC improve survival, QoL

Clinical trials on first-line therapies for advanced or metastatic nonsmall cell lung cancer (NSCLC) from 2010 to 2020 have reported better survival and a steady improvement in quality of life (QoL) among patients, according to the results of a systematic review.

“However, there were more than twice as many studies reporting positive authors’ conclusions as studies meeting the ESMO threshold for meaningful clinical benefit,” the investigators said.

Published phase II and phase III clinical trials were included in this systematic review, conducted through a structured search using the databases of Embase and Medline. The investigators collected a comprehensive set of variables to examine their impact on survival rates. They also estimated the clinical benefit by applying the ESMO-MCBS v1.1 and extracted the conclusions of the study authors.

Sixty-six studies, including 34,951 patients, met the eligibility criteria. Best survival outcomes were observed for NSCLC (median overall survival [OS], 19.4 months; median progression-free survival [PFS], 10.2 months) and for those expressing molecular targets (median OS, 23.8 months; median PFS, 11.0 months). Industry funding and disease stage (IIIB/IV vs IV) showed no significant effect on survival rates.

Forty-five studies applied the ESMO-MCBS v1.1, which resulted in a meaningful clinical benefit score in 37.8 percent. Of the original publications, 57.6 percent reported QoL, of which 33.3 percent reached statistical significance favouring the experimental arm.

Notably, “[p]ositive authors’ conclusions (75.7 percent of trials) were based on OS and/or QoL in 34 percent and on surrogate endpoints in 66 percent,” the investigators said.