Evolving Patterns of Care, Outcomes and Ongoing Challenges for Early-Stage Non-Small Cell Lung Cancer in the Immunotherapy Era: A Queensland Population-Based Study

Abstract

Introduction: This retrospective study describes contemporary patterns of care and outcomes for early-stage non-small cell lung cancer (NSCLC) in Queensland, Australia, with a focus on immunotherapy. Methods: Population-based data for patients with NSCLC diagnosed at stages I-III between 2018 and 2022 were sourced from the Queensland Oncology Repository. Follow-up on treatment and mortality was available to 31 December 2024. Poisson models were used to determine patient and clinical characteristics associated with the treatments received. Differences in five-year observed survival were calculated from multivariable flexible parametric models. Results: The study cohort comprised 4608 patients. Surgery alone was the most common treatment modality for stages I and II (55% and 27%, respectively), whereas 44% of patients with stage III disease had concurrent chemoradiotherapy without surgery. Just over half (53%) of this latter group were also treated with durvalumab. First Nations people were somewhat less likely to receive either surgery (relative likelihood = 0.95, 95% CI 0.91–1.00; p = 0.04) or chemotherapy (RL = 0.95, 95% CI 0.90–0.99; p = 0.03) compared to other Queensland residents. Five-year observed survival ranged from 17% (95% CI 11%–25%) for stage IIIC to 81% (95% CI 74%–87%) for stage IA1. Patients with unresected stage III disease who received concurrent chemoradiotherapy with subsequent durvalumab were 37% less likely to die from NSCLC within 5 years of diagnosis than chemoradiotherapy alone (hazard ratio = 0.63, 95% CI 0.51–0.78; p < 0.001). Conclusions: Disparities in treatment for First Nation people with NSCLC require urgent attention. Durvalumab provides a survival advantage for unresectable stage III NSCLC within a real-world setting.