(CSPOT36) Real-world Treatment Pattern and Overall Survival of Stage III and IV Non‑Small‑Cell Lung Cancer Patients: An Analysis using German Cancer Registry Data

Background: Lung cancer is one of the most common cancers and the leading cause of cancer-related mortality worldwide. Between 85-90% of lung cancers are non-small cell lung cancers (NSCLC), which are further categorized in disease stages according to lymph node involvement, tumor size, and distant metastases. Patients in advanced stages (stage III and IV; aNSCLC) are especially prone to high mortality rates.

Objectives: This study aims to describe patient characteristics, real-world treatment patterns, and overall survival (OS) in NSCLC patients.

Methods: A retrospective analysis based on data from the Saxon Cancer Registry containing more than 880,000 cancer patients was conducted. Patients diagnosed with stage IIIb/c or IV NSCLC from January 1, 2015, until December 31, 2019, were included. Patient characteristics and treatment patterns were analyzed using descriptive statistics. OS was assessed by employing Kaplan-Meier estimation.

Results: In total, 731 stage IIIB, 158 stage IIIC, and 3,969 stage IV patients were included in the analysis. The mean age at diagnosis of the overall aNSCLC sample was 69.2 (SD: 10.7) years, with a majority of patients being male (n=3,468; 71.4%). The most common pathologies were adenocarcinoma (49.4%) and squamous cell carcinoma (15.0%). Out of 3,435 patients who received any treatment (70.7%), targeted therapy + chemotherapy (21.9%), chemotherapy only (14.1%), and targeted therapy + chemotherapy + radiotherapy (8.0%) were the most commonly observed treatment regimens. Only 5.2% of patients received any surgery. Treatment patterns differed between disease stages, with targeted therapy only, targeted therapy + chemotherapy, and chemotherapy only being more and radiotherapy only and radiotherapy + chemotherapy being less frequently prescribed in stage IV than in stage III. Median OS from diagnosis was 7.49 months (95%-CI: 7.06-7.92) overall, 13.01 months (95%-CI: 11.89-14.55) in stage III patients, and 6.51 months (95%-CI: 6.05-6.93) in stage IV patients, with a three-year-survival probability of 11.5%, 20.42%, and 9.5%, respectively. Patients who did not initiate any therapy (n=1,423), who were significantly older (on average 73.3 vs. 67.5 years, p< 0.001) and more likely to be affected by metastatic stage (89.2% vs. 78.6%, p< 0.001) than treated patients, had the shortest median OS (2.37 months; 95%-CI: 2.23-2.5).

Conclusions: Our analysis showed that the prognosis of aNSCLC patients in Germany is still poor. One-third of aNSCLC patients, with a median OS of less than three months, did not receive any treatment, indicating a remaining need for strategies for earlier diagnosis and research on treatment options for later stages.