Real-world outcomes in patients with biomarker-selected early-stage non-small cell lung cancer
Recommended Citation
Abu Rous F, Sussell J, Ngiam C, Zhang Q, Majda T, Sheinson D, Ogale S, Bara I, Schulze K, Gadgeel SM. Real-world outcomes in patients with biomarker-selected early-stage non-small cell lung cancer. J Clin Oncol 2024; 42(16).
Document Type
Conference Proceeding
Publication Date
5-29-2024
Publication Title
J Clin Oncol
Keywords
biological marker, epidermal growth factor receptor, adult, aged, cohort analysis, conference abstract, controlled study, female, histology, human, major clinical study, male, non small cell lung cancer, overall survival, people by smoking status, radiotherapy, retrospective study, surgery
Abstract
Background: Extensive literature has assessed the prognostic value of Lung driver mutations (LDMs) in advanced non-small cell lung cancer (aNSCLC). However, their role in predicting outcomes in early-stage cases (eNSCLC) is less defined due to limited data on biomarkerselected eNSCLC. Study variations have led to diverse findings on the prognostic value of individual LDMs in eNSCLC. Methods: We retrospectively analyzed patients with resected stage I-IIIa NSCLC diagnosed between 2011-2023 using the nationwide (US-based) de-identified Flatiron Health-Foundation Medicine lung clinico-genomic database, which consolidates data from approximately 280 US cancer clinics (~800 sites of care). We allocated patients to five cohorts classified by early-stageLDMstatus: ALK+, EGFR+, KRAS G12C+, KRAS non-G12C+ and wild-type (WT - negative for the listed biomarkers). The clinical attributes and treatment patterns for this cohort were described by our group in a previous abstract; here we analyze recurrence-free and overall survival (RFS and OS) by cohort, using the Kaplan-Meier method. We used Cox regression for multivariate analysis, controlling for demographic and clinical characteristics including age, race, insurance status, stage, histology, and smoking status. Results: The sample contained 1,595 stage I-IIIa patients with known LDM status. Of these, 2.8%, 20.4%, 10.7%, 19.3%, and 46.8% were ALK+, EGFR+, KRAS G12C+, KRAS non-G12C+, and WT. Median OS and RFS were shorter in the WT group compared to any LDM group; results can be found in the table. These differences in OS and RFS persisted in multivariate analysis; hazard ratios (HR) were all statistically significant (p,0.05) and can be found in the table below. Conclusions: In this real-world analysis, patients with eNSCLC LDM-positive tumors had improved OS and RFS relative toWTpatients. Differences in OS betweenWTand LDM+ patients are likely due to frequent receipt of targeted therapy (TT) following progression to advanced disease. However, the small fraction of patients that received adjuvant TT within 6 months of surgery (described in our previous abstract) is not likely to explain observed differences in RFS; thus the differences may be due to innate characteristics of these LDMs.
PubMed ID
Not assigned.
Volume
42
Issue
16
