Treatment patterns and long-term survival for unresected stage III non-small cell lung cancer patients: A nationwide register study in Denmark

Abstract

Background: Patients with stage III non-small cell lung cancer (NSCLC) is a heterogeneous population with resectable or unresectable tumors. Current standard of care for unresectable disease has since long been either curatively intended chemoradiotherapy (CRT) followed by active surveillance, or palliative treatment for CRT ineligible patients. Recently, published data have shown survival benefit of CRT followed by immunotherapy (durvalumab). The aim was to investigate long-termsurvival, treatment patterns, and characteristics for unresected stage III NSCLC patients in a real-life setting. Method(s): This nationwide study identified all stage III NSCLC patients diagnosed in Denmark during 2006-2015 in the Danish Cancer Registry. Patient and tumor data were linked with data on resection, CRT, radiotherapy only [RT], chemotherapy only [CT] and comorbidity from the National Patient Registry. Survival rates were estimated from date of diagnosis until death, migration, or end of study (2016) using Kaplan- Meier curves. Result(s): During the study period, 33,747 patients were diagnosed with NSCLC, of which 7390 (22%) had stage III disease. Of these, 5919 (80%) patients were unresected, and they were older (mean age 69.2 vs. 65.8 years), more frequently men (55.0% vs. 51.5%), and had more comorbidity (39.8% vs. 33.6% one comorbidity) compared to the resected patients. Among the unresected patients, 40.5% received CRT, 15.1% RT, 15.6% CT, and 28.8% had no treatment. Patients receiving CRT were younger and had less comorbidity than patients receiving RT or CT only. The 5-year overall survival rates in the unresected group were: 10.6% CRT, 4.5% RT, and 3.6% for patients treated with CT. Among the resected stage III NSCLC patients, 42% survived >=5 years. Conclusion(s): The poor long-term survival rates observed among unresected stage III NSCLC patients indicate a high unmet need for more effective therapy. New treatment strategies, including CRT followed by immunotherapy, might improve long-term outcomes for these patients. Increased utilization of biomarkers and correctly targeted therapies has the potential to personalize and improve treatment of stage III NSCLC.