Real-world treatment patterns and outcomes for patients with non-metastatic non-small cell lung cancer: retrospective analyses in Canada, England, and Germany

Abstract

Background: Recent therapeutic advancements for non-metastatic non-small cell lung cancer (NSCLC) have increased the need for real-world baselines against which future changes in patient management and clinical outcomes can be compared. Methods: Data on patient characteristics, initial treatment, and overall survival (OS) were derived from adult patients diagnosed with stage I-IIIC NSCLC (2010–2020) in a regional Canadian database (Oncology Outcomes [O2]), an English national registry (Cancer Analysis System [CAS]), and four regional German registries (VONKOdb) and retrospectively analyzed separately using analogous methodology. Results: Data from 85,433 patients were analyzed. Stage at diagnosis varied, with proportions with stage I NSCLC ranging from 30.9% (VONKOdb) to 44.2% (O2) and with stage III disease from 36.9% (O2) to 48.5% (VONKOdb). Across the data sources, proportions receiving surgery ± other treatments were similar for stages I and II, but decreased through stages IIIA, IIIB, and IIIC (range, 24.7–42.7%, 4.6–21.8%, and 0.9–7.5%, respectively). Overall, 70.3–85.2% of patients received active treatment for NSCLC, with a trend toward lower proportions among those with stage III disease. Reached median OS tended to be longest in patients with resected stage I/II NSCLC (range, 28.8–128.0 months) and shortest in patients with stage IIIB/IIIC disease treated with systemic anticancer therapy (SACT) alone, radiotherapy alone, or SACT + palliative radiotherapy (range, 4.8–21.2 months). Conclusions: These data provide insights into treatment pathways and survival outcomes before the widespread use of immunotherapy-based and targeted therapies and will serve as an important baseline for future evaluations of emerging treatments for patients with non-metastatic NSCLC.