Real-world clinical practice and outcomes in treating stage III non-small cell lung cancer: KINDLE-Asia subset

Abstract

IntroductionStage III non-small cell lung cancer (NSCLC) is a heterogeneous disease requiring multimodal treatment approaches. KINDLE-Asia, as part of a real world global study, evaluated treatment patterns and associated survival outcomes in stage III NSCLC in Asia.MethodsRetrospective data from 57 centers in patients with stage III NSCLC diagnosed between January 2013 and December 2017 were analyzed. Median progression free survival (mPFS) and median overall survival (mOS) estimates with two sided 95% confidence interval (CI) were determined by applying the Kaplan-Meier survival analysis.ResultsOf the total 1874 patients (median age: 63.0 years [24 to 92]) enrolled in the Asia subset, 74.8% were men, 54.7% had stage IIIA disease, 55.7% had adenocarcinoma, 34.3% had epidermal growth factor receptor mutations (EGFRm) and 50.3% had programmed death-ligand 1 (PD-L1) expression (i.e. PD-L1 ≥1%). Of the 31 treatment approaches as initial therapy, concurrent chemoradiotherapy (CRT) was the most frequent (29.3%), followed by chemotherapy (14.8%), sequential CRT (9.5%), and radiotherapy (8.5%). Targeted therapy alone was used in 81 patients of the overall population. For the Asia cohort, the mPFS and mOS were 12.8 months (95% CI, 12.2–13.7) and 42.3 months (95% CI, 38.1–46.8), respectively. Stage IIIA disease, Eastern Cooperative Oncology Group ≤1, age ≤65 years, adenocarcinoma histology and surgery/concurrent CRT as initial therapy correlated with better mOS (p < 0.05).ConclusionsThe results demonstrate diverse treatment patterns and survival outcomes in the Asian region. The high prevalence of EGFRm and PD-L1 expression in stage III NSCLC in Asia suggests the need for expanding access to molecular testing for guiding treatment strategies with tyrosine kinase inhibitors and immunotherapies in this region.

Efficacy of Definitive Radiotherapy for Patients with Clinical Stage IIIB or IIIC Lung Adenocarcinoma and Epidermal Growth Factor Receptor (EGFR) Mutations Treated Using First- or Second-Generation EGFR Tyrosine Kinase Inhibitors

“…To the best of our knowledge, this is the first population-based study to explore this specific topic. The outcomes of our investigation, which showed no statistically significant effect of RT on OS, align with the findings reported in the KINDLE study, [ 10 , 11 ] as the 95% confidence intervals overlapped; however, it is important to note that the KINDLE study reported a numerically longer median OS for the RT group (42.6 months) compared to the non-RT group (25.4 months), whereas our study found similar OS values in both groups.…”

“…Another RCT for patients with unresectable stage III NSCLC with EGFR mutations showed that erlotinib plus RT significantly improved progression-free survival relative to dCCRT [ 9 ]. A search conducted on PubMed using the terms, “((non-small-cell lung) OR (lung adenocarcinoma)) AND ((locally advanced) OR (stage III)) AND (EGFR mutation) AND ((radiation) OR (radiotherapy)) AND (gefitinib OR erlotinib OR afatinib OR dacomitinib OR osimertinib OR (tyrosine kinase inhibitor ∗ )),” in June 2023 yielded no relevant RCTs, only the observational KINDLE study [ 10 , 11 ]. Given the aforementioned controversy and the limited literature available on this topic, we designed this retrospective cohort study to investigate the efficacy of definitive RT for patients with clinical stage IIIB or IIIC lung adenocarcinoma and EGFR mutations treated with first- or second-generation EGFR TKIs using a population-based approach.…”

Challenges and controversies in resectable non-small cell lung cancer: a clinician’s perspective

“… 55 Comparable challenges persist in Central and Eastern European nations, and data from an Asian study showed just 32% of stage III NSCLC cases underwent MDT discussions. 56 , 57 Barriers like infrastructure, logistics, financial limitations, and expert shortages hinder MDT adoption. 58 …”