2023 World Conference on Lung Cancer (Posters)-EP08.02. Evaluation of Treatment Strategies for Patients with Stage IIIA Non-Small Cell Lung Cancer in the Immunotherapy Era

EP08.02. Evaluation of Treatment Strategies for Patients with Stage IIIA Non-Small Cell Lung Cancer in the Immunotherapy Era - PDF(Abstract)

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In this study presented at WCLC 2023, the authors evaluated treatment strategies for patients with Stage IIIA non-small cell lung cancer (NSCLC) in the era of immunotherapy. The optimal treatment for these patients is still controversial. The NCCN recommends different approaches based on the extent of the disease, such as resection of bulky local disease, concurrent chemoradiation (DC) with immunotherapy for extensive nodal involvement, and neoadjuvant therapy for downstaging. However, there is growing evidence that resection combined with chemotherapy before or after surgery may be superior to DC. <br /><br />The study included adults diagnosed with stage IIIA NSCLC between 2017-2021 who started treatment within 6 months of diagnosis. The data was sourced from ConcertAI's Patient360TM NSCLC product, a comprehensive oncology database of real-world data from US academic and community electronic health records. Patients treated with targeted therapy, upstaged prior to treatment, T3/N2 disease, or with a second primary cancer within one year of diagnosis were excluded.<br /><br />Progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan Meier and Cox proportional hazard methods. The researchers used propensity score-derived inverse probability treatment weighting (IPTW) to balance baseline differences between the treatment groups.<br /><br />The results showed that among the 2223 eligible patients, 25% received surgery with chemotherapy (SC) and 32% received concurrent chemoradiation with immunotherapy (DCI). The use of guideline-recommended treatment varied among different community practices. When compared to patients treated with DCI, patients treated with SC had a 24% lower hazard of progression and a 35% lower hazard of overall mortality after adjusting for baseline differences. This result was consistent for patients with N2 and N0/N1 disease.<br /><br />The study concludes that the use of NCCN recommended therapies for stage IIIA NSCLC varies considerably among US oncology practices, which may reflect preference-guided rather than evidence-guided decisions. Surgery with chemotherapy was associated with improved survival and progression-free survival compared to chemoradiation with consolidation immunotherapy.

Asset Subtitle

Amy Alabaster

Meta Tag

Speaker Amy Alabaster

Topic Local-Regional NSCLC: Multimodality Therapy

Keywords

Stage IIIA non-small cell lung cancer

immunotherapy

treatment strategies

NCCN recommendations

concurrent chemoradiation

neoadjuvant therapy

resection combined with chemotherapy

real-world data

progression-free survival

overall survival