Background: Non-small cell lung cancer (NSCLC) commonly presents at advanced stage. We previously reported systemic treatment uptake in stage IV NSCLC climbing from 55% (2009–2012) to 62% (2015–2017). Since then, first-line immunotherapy and 2nd/3rd generation tyrosine kinase inhibitors (TKIs) have emerged as standards of care. We explored whether treatment rates continued to rise and studied outcomes. Methods: We reviewed all cases of de novo stage IIIB/IIIC/IV NSCLC seen in out-patient medical oncology consultation at our institution between 2009–2012 (cohort A), 2015–2017 (cohort B), and June–December 2018 (cohort C). We compared rates of systemic treatment, molecular testing, targeted therapy, and immune checkpoint inhibitor (ICI) use. We compared survival in the overall, treated/untreated, younger and elderly population in cohort A vs. cohort B + C (= cohort D). Results: Cohorts A, B, and C included 528, 463, and 93 patients, respectively. Overall, 66% received any systemic therapy in cohort C, compared to 62% in cohort B and 55% in cohort A. Across three time periods, first-line chemotherapy rates fell (93, 76, 46%) while rates of first-line targeted therapy (5, 16, 15%) and ICI (0, 2, 36%) rose. Among molecular subtypes, first-line targeted treatment in EGFR-positive patients (63, 94, 100%) and anaplastic lymphoma kinase (ALK)-positive patients (0, 91, 100%) rose. Survival improved in all subgroups in cohort D vs. cohort A, except for patients ≥70 years and the untreated population. Conclusions: Systemic treatment rose across three time periods, reflecting the introduction of rapid diagnostic pathways, reflex molecular testing, ICI, and targeted therapies. Survival outcomes of advanced NSCLC patients have significantly improved.

中文翻译：

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晚期非小细胞肺癌全身治疗吸收和存活率的演变

背景：非小细胞肺癌 (NSCLC) 通常出现在晚期。我们之前报道了 IV 期 NSCLC 的全身治疗吸收率从 55%（2009-2012）攀升至 62%（2015-2017）。从那时起，一线免疫疗法和第 2/3 代酪氨酸激酶抑制剂 (TKI) 已成为护理标准。我们探讨了治疗率是否继续上升并研究了结果。方法：我们回顾了 2009-2012 年（队列 A）、2015-2017 年（队列 B）和 2018 年 6 月-12 月在我们机构的门诊肿瘤内科咨询中发现的所有新发 IIIB/IIIC/IV 期 NSCLC 病例（队列 C)。我们比较了全身治疗、分子检测、靶向治疗和免疫检查点抑制剂 (ICI) 的使用率。我们比较了队列 A 与队列 A 中的总体、治疗/未治疗、年轻和老年人群的生存率。队列 B + C（= 队列 D）。结果：队列 A、B 和 C 分别包括 528、463 和 93 名患者。总体而言，队列 C 中有 66% 接受了任何全身治疗，而队列 B 为 62%，队列 A 为 55%。在三个时间段内，一线化疗率下降（93%、76%、46%），而一线化疗率下降线靶向治疗 (5, 16, 15%) 和 ICI (0, 2, 36%) 上升。在分子亚型中，EGFR阳性患者（63%、94%、100%）和间变性淋巴瘤激酶（ALK）阳性患者（0%、91%、100%）的一线靶向治疗上升。除了 70 岁以上的患者和未接受治疗的人群外，队列 D 与队列 A 的所有亚组的生存率均有所提高。结论：系统治疗在三个时间段内上升，反映了快速诊断途径、反射分子检测、ICI 和靶向治疗的引入。