Summary
Both immunotherapy and targeted therapies have become part of routine lung cancer therapy; we analyzed the ASCO CancerLinQ database to study long-term outcomes for patients treated with targeted therapy and immunotherapy for advanced NSCLC.
Methods
The ASCO CancerLinQ Discovery dataset was queried to identify patients diagnosed with lung cancer between the years 2010-2018. Data on demographics, tumor stage, histology and treatments were extracted. Stage IV patients that had been treated with targeted therapy (TT), immunotherapy alone (ICI) or both in sequence (TIC) were included in this analysis. Univariate association (UVA) of each clinicopathological variable with treatment group was performed using Chi-square tests for categorical variables and ANOVA test for numerical variables. 5 year overall survival (OS) was investigated as the primary outcome. OS was calculated as the time from first diagnosis to the date of death or date of last available follow-up, and was estimated using the Kaplan-Meier method. The treatment groups of interest were compared using log-rank tests, and pair-wise comparisons were reported, where applicable. Other clinicopathological variables were similarly compared. 5-year overall survival rates were reported. All analyses were conducted using SAS 9.4.
Results
A total of 3,911 NSCLC patients with stage IV disease were included in this analysis. Patient characteristics: median age 65 years, 52% male, 73% White and 2.5% Hispanic. Approximately 77% were treated with ICI, 21% with TT and 3% received TT followed by ICI (TIC). On the UVA, 55% of patients treated with ICI comprised of males compared to 43% in TT and 31% in TIC groups (p<0.001). On KM analysis, the 5-year survival rates were 19% in ICI, 15% in TT, and 21% in TIC subgroups. The median survival was 1.9y vs 1.6y vs 3.2y in ICI, TT and TIC subgroups respectively. Females had significantly higher 5-year survival rate compared to males (17% vs. 12%; log-rank p=0.004) in the TT subgroup but were comparable with males in the other two subgroups [18.2% vs. 19.5% in ICI and 21.6% vs.20.3% in TIC]. Black patients had significantly higher 5-year survival rates compared to White [27.5% (CI 21.3%-34.1%) vs.16.5% (CI 14.2%-18.9%); log-rank p=0.0001) in the ICI subgroup but no significant differences in survival were seen in patients in the other two treatment subgroups based on race.
Conclusions
The 5-year survival rates with immunotherapy and targeted therapy were greater than 15% for advanced NSCLC; Black patients had a significantly better 5-year survival with immunotherapy.
