WCLC 2025 - Posters & ePosters-EP.17.25 The Transition of Treatment Choice for First-Line Treatment for Advanced or Recurrent NSCLC and the Patients’ Characteristics

EP.17.25 The Transition of Treatment Choice for First-Line Treatment for Advanced or Recurrent NSCLC and the Patients’ Characteristics

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This retrospective single-center study from Japan assessed changes in first-line treatment choices for advanced or postoperative recurrent non-small cell lung cancer (NSCLC) over a decade (2014-2024). The study analyzed patient characteristics, treatment eras, drug categories (targeted therapies, cytotoxic chemotherapy, immune checkpoint inhibitors [ICI]), and related severe adverse events (sAEs).<br /><br />Key findings include that targeted therapies and ICIs, introduced following approvals of osimertinib (Aug 2018) and pembrolizumab (Feb 2017) respectively, improved overall survival for advanced NSCLC patients. Patients with poor performance status (PS) and comorbidities, particularly interstitial lung disease (ILD), were more likely to receive cytotoxic therapies rather than targeted or ICI treatments. The target therapy groups before and after osimertinib approval maintained consistent patient characteristics, while the cytotoxic groups showed a higher proportion of patients with poor PS.<br /><br />Severe adverse events (grade ≥3) were more frequent in ICI-treated patients (24%) compared to targeted therapy (around 17%) and cytotoxic therapy (7-8%). Although ICIs increased survival, they also carried a higher risk of severe side effects. Molecular profiling led to identifying driver mutations (e.g., EGFR, ALK, ROS-1) in many patients, but only a small subset without initial driver mutations later underwent comprehensive genomic profiling, resulting in some targeted therapy use through trials or reimbursements.<br /><br />Limitations of the study include lack of data on treatment sequencing, PD-L1 expression levels, and subsequent therapies, which may affect outcomes. The study highlights challenges in treating an aging population with NSCLC, emphasizing the need to balance treatment efficacy and tolerability, especially in frail patients with comorbidities. Overall, the advent of targeted drugs and ICIs has significantly impacted NSCLC management, improving survival despite increased adverse events, underscoring the importance of personalized treatment strategies in clinical decision-making.

Asset Subtitle

Yuki Akazawa

Meta Tag

Speaker Yuki Akazawa

Topic Global Health, Health Services, and Health Economics

Keywords

non-small cell lung cancer

NSCLC

targeted therapies

immune checkpoint inhibitors

osimertinib

pembrolizumab

severe adverse events

performance status

interstitial lung disease

molecular profiling