Survival times of patients with metastatic non-small cell lung cancer (NSCLC) starting first-line chemotherapy in routine clinical practice versus contemporary randomised trials — ASN Events
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Survival times of patients with metastatic non-small cell lung cancer (NSCLC) starting first-line chemotherapy in routine clinical practice versus contemporary randomised trials (#307)

Jane L Parry 1 , Stephen A Della-Fiorentina 1 , Po Yee Yip 1 , Victoria Bray 2 , Belinda E Kiely 1
  1. Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia
  2. Medical Oncology, Liverpool Cancer Centre, Liverpool , NSW, Australia

Aims

To compare survival times for patients starting first-line chemotherapy for metastatic NSCLC in routine clinical practice with survival of patients enrolled in first-line chemotherapy clinical trials.

Methods

We identified all patients at Macarthur and Liverpool Cancer Centres who were diagnosed with metastatic NSCLC between July 2011 and July 2013 and subsequently started first-line chemotherapy. We recorded demographics, tumour and treatment characteristics, and survival times from the start of chemotherapy. Their survival distribution was summarized by the following percentiles (representative scenario for survival); 90th (worst-case), 75th (lower-typical), 25th (upper-typical) and 10th (best-case) which were compared with the same percentiles from a recent systematic review of first-line chemotherapy trials.1

Results

Characteristics of the 67 eligible patients were: median age, 62 years (range 31-81); male, 64%; ECOG performance status 0-1, 81%; liver metastases, 15% and brain metastases, 18%. The majority of tumours were adenocarcinomas (69%) and squamous cell carcinomas (12%) and 9% had documented EGFR mutations. The median time from diagnosis to starting chemotherapy was 45 days. Carboplatin and gemcitabine was the commonest chemotherapy regimen (97%) and the median number of cycles completed was 3. After 16 months median follow-up there were 47 deaths. Survival times in months (vs the systematic review) were: 90th percentile 2 (2); 75th percentile 3 (5); median 9 (9); 25th percentile 17 (16); 10th percentile 24 (25). Independent predictors of survival were age (HR 1.9, p=0.03), ECOG performance status 0-1 (HR 0.4, p=0.008) and adenocarcinoma (HR 0.4, p=0.006).

Conclusion

Median and better survival times in routine practice were similar to those from clinical trials; however, the shortest 25% of survival times (lower-typical scenario) was shorter in routine practice, likely reflecting patient selection in trials. Oncologists should adjust trial-based survival estimates for patients in routine practice not meeting typical trial eligibility criteria.

  1. BE Kiely, M Alam, P Blinman, MHN Tattersall, MR Stockler. Estimating typical, best-case and worst-case life expectancy scenarios for patients starting chemotherapyfor advance non-small-cell lung cancer: A systematic review of contemporary randomised trials. Lung Cancer 77 ( 2012) 537-544.
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