WCLC 2025 - Posters & ePosters-EP.17.33 Evolving Treatment Patterns in Early-Stage Non-Small Cell Lung Cancer in the United States

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This study evaluated evolving treatment patterns in early-stage non-small cell lung cancer (NSCLC) (stages IB–IIIA) in the United States from 2019 to 2023, focusing on immunotherapy (IO) and targeted therapy (TT) usage among patients undergoing surgical resection. Early-stage NSCLC accounts for approximately 30% of cases, with surgery plus systemic therapy as the standard of care. Despite treatment, up to two-thirds experience recurrence, underscoring an unmet need for therapies to prevent relapse.<br /><br />Using the Flatiron Health Research Database, a retrospective cohort of 14,638 patients diagnosed from 2018–2023 was analyzed; key characteristics included a median age of 70, predominance of non-squamous histology, and 29% positive for KRAS, 15.2% for EGFR mutations, 1.5% ALK positive, and 0.8% RET rearrangement. The study excluded patients with surgery outside specified diagnosis intervals.<br /><br />Results showed a rapid increase in IO and TT use from 2019 to 2023: IO use rose by 28.2% overall and 40.1% for stage II/IIIA patients. In 2023, 50% of stage II/IIIA patients received IO compared to 8.5% in 2019, with adjuvant IO being the dominant approach. TT use in EGFR-mutated patients increased to 58% in 2023 from 14.2% in 2019. Neoadjuvant and perioperative IO use also increased but remained lower than adjuvant therapy. Despite these advances, about half of patients without pathologic complete response (pCR) after neoadjuvant therapy did not receive subsequent adjuvant treatment.<br /><br />The study highlights significant paradigm shifts driven by clinical trials and recent FDA approvals enabling integrated perioperative IO and TT in early-stage NSCLC, improving systemic therapy adoption post-surgery. However, limitations include missing data and the analysis of TT use across all patients rather than mutation-positive subsets. Ongoing trials targeting additional mutations (KRAS, RET) may further expand early-stage treatment options. Continued real-world monitoring is recommended to assess uptake and optimize treatment strategies.

Asset Subtitle

Jhanelle Gray

Meta Tag

Speaker Jhanelle Gray

Topic Global Health, Health Services, and Health Economics

Keywords

early-stage non-small cell lung cancer

NSCLC

immunotherapy

targeted therapy

surgical resection

adjuvant therapy

neoadjuvant therapy

KRAS mutation

EGFR mutation

treatment patterns