Real World Treatment Patterns and Outcomes Among Patients with Early Non-Small Cell Lung Cancer

Abstract

Background: Worldwide, about two million people are diagnosed with lung cancer each year, 85% of whom have non-small cell lung cancer (NSCLC). Over the last fifteen years, noteworthy progress has been made in treating advanced metastatic NSCLC with targeted systemic therapies. As early and comprehensive care can potentially improve and extend the lives of patients, attention is now turning towards Stages I – IIIA, or early NSCLC (eNSCLC), with new and recent approval of neoadjuvant and adjuvant systemic therapies. With this rapidly changing treatment landscape, it is critical to understand how care is implemented and to whom, to appreciate the real-world adoption of innovative treatments in eNSCLC as they enter the market. Methods: This retrospective observational study used Flatiron Health, a US nationwide electronic health record derived and de-identified database spanning from January 2019 - March 2024 to (1) describe eNSCLC patient demographic and clinical characteristics, (2) the real-world neoadjuvant and adjuvant treatment patterns, and (3) how these treatment patterns relate to long-term patient outcomes. Results: We studied 7,410 patients, mostly female (52.9%), with a mean age of 71.0 ± 8.5 years. Most were diagnosed at Stage I (n = 4,098), with the rest at Stages II and IIIA. About 65% received curative-intent treatment: surgery (50%), radiation (4.6%), or chemoradiation (10.7%). The rest did not receive definitive treatment. Neoadjuvant use was rare, and adjuvant use was limited. Surgical patients, primarily at Stage I, did not receive adjuvant or neoadjuvant systemic therapy (62.1%). In contrast, smaller fractions of definitive radiation or chemoradiation treatment groups went without neoadjuvant / adjuvant systemic therapies, 24.6% and 50% respectively. Immunotherapy monotherapy was the most common adjuvant therapy for patients undergoing definitive radiation or chemoradiation, while surgical patients received platinum chemotherapy. Survival outcomes were higher for patients treated with adjuvant systemic therapy following definitive radiation or chemoradiation. Patients undergoing definitive radiation without neoadjuvant / adjuvant systemic therapy had lower survival rates, but adjuvant therapy improved these rates. A similar trend was observed in patients who received chemoradiation. Conclusions: The landscape of treatment possibilities for patients diagnosed with eNSCLC is expanding rapidly. However, our comprehension of how these advancements is integrated into clinical practice and their impact on patient outcomes is just starting to unfold. A crucial initial step in improving patient outcomes is to confront and address the underutilization of neoadjuvant / adjuvant systemic therapy for eNSCLC patients.