Treatment strategy, overall survival and associated risk factors among patients with unresectable stage IIIB/IV non-small cell lung cancer in China (2015-2017): A multicentre prospective study

Yuankai Shi; Xin Zhang; Gang Wu; Jianping Xu; Yong He; Dong Wang; Cheng Huang; Mingwei Chen; Ping Yu; Yan Yu; Wei Li; Qi Li; Xiaohua Hu; Jinjing Xia; Lilian Bu; Angela Yin; Yigong Zhou

doi:10.1016/j.lanwpc.2022.100452

Treatment strategy, overall survival and associated risk factors among patients with unresectable stage IIIB/IV non-small cell lung cancer in China (2015-2017): A multicentre prospective study

Lancet Reg Health West Pac. 2022 Apr 11:23:100452. doi: 10.1016/j.lanwpc.2022.100452. eCollection 2022 Jun.

Authors

Yuankai Shi¹, Xin Zhang², Gang Wu³, Jianping Xu¹, Yong He⁴, Dong Wang⁵, Cheng Huang⁶, Mingwei Chen⁷, Ping Yu⁸, Yan Yu⁹, Wei Li¹⁰, Qi Li¹¹, Xiaohua Hu¹², Jinjing Xia¹³, Lilian Bu¹³, Angela Yin¹⁴, Yigong Zhou¹⁴

Affiliations

¹ Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China.
² Respiratory Diseases Department, Zhongshan Hospital Fudan University, Shanghai, China.
³ Cancer Center, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴ Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Chongqing, China.
⁵ Cancer Center, Daping Hospital, Third Military Medical University, Chongqing, China.
⁶ Department of Medical Oncology, Fujian Cancer Hospital, Fuzhou, China.
⁷ Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
⁸ Department of Thoracic Oncology, Sichuan Cancer Hospital, Chengdu, China.
⁹ Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
¹⁰ Cancer Center, The First Hospital of Jilin University, Changchun, China.
¹¹ Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
¹² Department of Medical Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
¹³ Department of Medical Science Oncology, Shanghai Roche Pharmaceuticals Ltd., Shanghai, China.
¹⁴ Real World Solutions, IQVIA, Beijing, China.

Abstract

Background: There are limited studies on treatment and survival analysis among patients with unresectable Stage IIIB or IV non-small cell lung cancer (NSCLC) in routine practice in China. To address this gap, we conducted a prospective observational study in a cohort of patients treated at 11 hospitals in China.

Methods: This was a multicentre, prospective cohort study including patients with newly diagnosed unresectable Stage IIIB or IV NSCLC from June 26th, 2015 to April 28th, 2017. Patient baseline characteristics, disease characteristics, and anti-cancer treatments were obtained by medical chart review. The overall survival (OS) from the initiation of first-line treatment was analysed by the Kaplan-Meier method. Factors associated with survival were analysed by univariate and multivariate Cox regression models.

Findings: Among 1324 patients enrolled with median follow-up duration of 15·0 (range: 0·0-42·1) months, 83·5% (1105/1324) of them received first-line chemotherapy of which platinum-based compounds were the dominated agents. Overall, 30·9% (409/1324) of patients received targeted therapy as 1st-line treatment including 65·0% (266/409) EGFR-TKIs and 5·1% (21/409) ALK-TKIs. Of all eligible patients, gene testing rates were 44·0% (583/1324) for EGFR mutations, 17·0% (225/1324) for EML4-ALK gene fusions, and 8·3% (110/1324) for ROS1 gene fusions. The EGFR-TKIs were administered to 63·9% (179/280) of EGFR mutated patients as first-line treatment. The overall median OS was 23·2 (95%CI 19·5-25·5) months, and patients treated at tier 1 cities had better OS than that of tier 2 cities. Also, the OS in patients with EGFR mutation was longer than those with EGFR wild type. Multivariate Cox regression models suggested that male, education below high school, tier 2 cities, smoking history, and multiple metastases were associated with poor survival.

Interpretation: The gene test coverage was relatively low among the studied population, and over half of EGFR mutated patients received EGFR-TKIs, suggesting that the result of genetic tests in real-world settings may not always indicate the selection of treatment. The OS benefit observed from patients treated in tier 1 cities and those with EGFR mutation may indicate a need for broader gene test coverage, providing NSCLC patients with personalized treatment according to the results of genetic tests.

Funding: Roche Holding AG.TRANSLATED ABSTRACT: This translation in Chinese was submitted by the authors and we reproduce it as supplied. It has not been peer reviewed. Our editorial processes have only been applied to the original abstract in English, which should serve as reference for this manuscript.:IIIBIV(NSCLC)., ,, 11.:,, 20156262017428IIIBIVNSCLC.,.Kaplan-Meier(OS), Cox.:1324, 15.0(:0.0-42.1), 83.5%(1105/1324), ., 30.9%(409/1324), 65.0%(266/409)EGFR-TKI5.1%(21/409)ALK-TKI., EGFR,EML4-ALKROS144.0%(583/1324),17.0%(225/1324)8.3%(110/1324).63.9%(179/280)EGFREGFR-TKI.23.2 (95% 19·5-25·5) , ., EGFREGFR.Cox, ,,,.:, EGFREGFR-TKI, , .EGFR, , NSCLC.

Keywords: China; NSCLC; Overall survival; Prospective study; Risk factors; Treatment strategy.