Survival Improvement of Stage IV Non-small Cell Lung Cancer in the Immunotherapy Era: A Retrospective Cohort Study in a US Population

IF 3.4 3区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL Advances in Therapy Pub Date : 2024-10-28 DOI:10.1007/s12325-024-03027-0

Lianfang Ni, Zhigang Zhang, Dan Sun, Zhonghui Liu, Xinmin Liu

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Abstract

Introduction

Immune checkpoint inhibitors (ICIs) greatly improved outcomes of stage IV non-small cell lung cancer (NSCLC) in randomized clinical trials. Limited data exists regarding the survival improvement of ICI use at the population level.

Methods

Clinical data of patients with pathologically confirmed stage IV NSCLC diagnosed in 2013 and 2017 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Survival outcomes were compared before and after ICI use to assess the survival improvement in the immunotherapy era in the real world.

Results

A total of 19,433 patients with stage IV NSCLC were included. Being female, age < 60 years, of American Indian and Asian or Pacific Islander race, married, non-squamous histology, without bone, brain, or liver metastases, and receiving chemotherapy were significantly associated with better prognosis in multivariable analyses. Propensity score matching (PSM) based on associated factors resulted in 8743 patients each in the non-immunotherapy and immunotherapy groups (1:1 ratio). After PSM, both overall survival (OS) (p < 0.001) and cancer-specific survival (CSS) (p < 0.001) were significantly improved in the immunotherapy group. The median OS (mOS) was 6.0 months in the non-immunotherapy group and 8.0 months in the immunotherapy group. The 1-, 2-, and 3-year OS rate was 29.0%, 14.2%, and 8.5% in the non-immunotherapy group, and 37.8%, 23.5%, and 16.7% in the immunotherapy group, respectively. Patients who were male, under 60 years old, married, white, had adenocarcinoma, had no bone or liver metastases, and received chemotherapy or radiation therapy were more likely to benefit from immunotherapy.

Conclusions

Survival outcomes of patients with stage IV NSCLC were significantly improved in the immunotherapy era. Population-level benefits of survival varied among subgroups, and not all the increase in OS meant a clinically meaningful benefit.

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免疫疗法时代 IV 期非小细胞肺癌生存率的提高：美国人群的回顾性队列研究

简介在随机临床试验中，免疫检查点抑制剂（ICIs）大大改善了IV期非小细胞肺癌（NSCLC）的治疗效果。有关使用 ICI 在人群中改善生存率的数据有限：从监测、流行病学和最终结果（SEER）数据库中提取了2013年和2017年确诊的病理确诊IV期NSCLC患者的临床数据。对使用 ICI 前后的生存结果进行了比较，以评估免疫疗法时代在现实世界中的生存改善情况：结果：共纳入了 19,433 例 IV 期 NSCLC 患者。女性、年龄在免疫疗法时代，IV 期 NSCLC 患者的生存率显著提高。不同亚组的人群生存获益各不相同，并非所有OS的增加都意味着有临床意义的获益。

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来源期刊

Advances in Therapy 医学-药学

CiteScore

7.20

自引率

2.60%

发文量

353

审稿时长

6-12 weeks

期刊介绍： Advances in Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Advances in Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.