Demographics, clinical characteristics, treatment patterns and clinical outcomes of patients with stages I-III resected NSCLC without known EGFR mutations

This retrospective study describes demographics, clinical characteristics, treatment (Tx) patterns and clinical outcomes of resected patients (pts) diagnosed with Stages (S) I–III non-small-cell lung cancer (rNSCLC) without known EGFR mutations in the US CancerLinQ database.

Pts diagnosed with SI-III NSCLC from 1 Jan 2014 to 31 Aug 2020 who underwent resection within 140 d after initial diagnosis were included and followed for survival and recurrence until their last recorded clinical visit, death or 31 Aug 2021 (data cutoff). The following Tx patterns were identified: surgery only (SO), neoadjuvant therapy + surgery (NT), surgery + adjuvant therapy (AT) and neoadjuvant + surgery + adjuvant therapy (NAT).

3329 pts met the study criteria. Median age at diagnosis was 68 yr (range 24–91). Among 2424 pts with known smoking status, 89.4% were current/former smokers. Of 1565 pts with comorbidity data, 59.9% had ≥1 comorbidity using the Elixhauser index. 54.7% were SI, 29.3% SII and 16.0% SIII. Across SI–III, 71.6% had SO, 25.2% had AT, 1.9% had NT and 1.4% had NAT; 51.5% of SII and 42.9% of SIII pts had SO. Surgery included lobectomy (74.7%), wedge resection (14.6%), pneumonectomy (5.0%), bilobectomy (3.4%) or segmentectomy (2.3%). Of pts with AT, most received chemotherapy only (75.2%), chemoradiotherapy (15.4%) or radiotherapy only (7.5%), while only 1.0% received immunotherapy (IO) at all. Kaplan-Meier estimated survival at 5 yr was 65.4% (95% CI: 63.0–67.7) across all stages, 72.6% (95% CI: 69.4–75.5) for SI, 61.6% (95% CI: 57.1–65.8) for SII and 47.9% (95% CI: 42.1–53.6) for SIII.

In contrast to NCCN recommendations for systemic therapy of pts with early-stage disease, nearly half of either SII or SIII rNSCLC pts received SO in this study. Of those treated with systemic therapy, the majority received AT of whom most received chemotherapy only. This study describes US clinical practice in the rNSCLC landscape, prior to the introduction of neo/adjuvant and perioperative IO. Effective multidisciplinary team management of pts may increase use of systemic Tx for eligible pts, helping to improve pt outcomes.