WCLC 2025 - Posters & ePosters-P1.11.77 A Comprehensive Analysis of Front-Line Regimens for Stage IV Non-Squamous Non-Small Cell Lung Cancer: A 13-Year Experience

P1.11.77 A Comprehensive Analysis of Front-Line Regimens for Stage IV Non-Squamous Non-Small Cell Lung Cancer: A 13-Year Experience

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This retrospective study analyzed 1,518 patients with stage IV non-squamous non-small cell lung cancer (NS NSCLC) treated at the Cleveland Clinic from 2010 to 2022. The cohort was predominantly adenocarcinoma (97%). Treatments were categorized into conventional chemotherapy (CTX, 49%), immunotherapy (IT, 12%), combined CTX-IT (21%), and targeted therapies (18%). The study aimed to compare overall survival (OS) outcomes between traditional chemotherapy and modern regimens, including immunotherapy and targeted agents.<br /><br />Key findings revealed that modern treatment regimens improved OS by 28% relative to conventional CTX (hazard ratio [HR] 0.72; p<0.001). The overall response rate was 58%, with median follow-up of nearly four years. Two- and five-year OS rates were 30% and 12%, respectively. Within the conventional CTX group, adding bevacizumab to carboplatin and pemetrexed or paclitaxel improved OS (HR 0.75; p=0.012), and pemetrexed was more effective than paclitaxel (HR 0.79; p=0.047).<br /><br />Molecularly targeted therapies showed differential benefits: in EGFR-mutated NS NSCLC, first-line osimertinib conferred superior OS compared to erlotinib (HR 0.59; p=0.003), but not afatinib. For ALK-mutated disease, alectinib was associated with significantly better OS than crizotinib (HR 4.4; p=0.001).<br /><br />The study underscores the substantial survival improvements achieved through modern therapies incorporating immunotherapy and targeted agents compared to earlier chemotherapy standards. It advocates for expanded molecular testing and individualized treatment optimization. These insights represent the largest real-world evidence confirming the survival benefit of newer therapeutic strategies in stage IV NS NSCLC and help guide future research addressing unmet clinical needs.

Asset Subtitle

Naveen Rehman

Meta Tag

Speaker Naveen Rehman

Topic Metastatic Non-small Cell Lung Cancer – Immunotherapy

Keywords

stage IV non-small cell lung cancer

non-squamous NSCLC

adenocarcinoma

conventional chemotherapy

immunotherapy

targeted therapies

overall survival

bevacizumab

EGFR mutation

ALK mutation