Survival Trends in Histologic Subtypes of Metastatic Non-Small Cell Lung Cancer (mNSCLC) in the United States: 2000-2010

Olszewski, Adam J.; Ali, Shihab; Witherby, Sabrina M.

doi:10.1016/j.ijrobp.2014.08.269

Cited by 8 publications

(10 citation statements)

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“…Interestingly, erlotinib-treated patients with squamous tumors tended to live longer than patients with non-squamous EGFR wild-type carcinoma, which contradicts previous findings that the prognosis of adenocarcinoma patients is generally better than that of patients with squamous tumors [ 10 ]. The finding is unexpected considering the very low EGFR mutation rate in squamous tumors but may be explained by EGFR gene amplifications frequently found in these tumors [ 44 , 45 ].…”

Section: Discussioncontrasting

confidence: 70%

“…NSCLC is histologically classified into the major subtypes adenocarcinoma (~ 40%) [ 4 , 5 ], squamous cell carcinoma (~ 30–40%) [ 6 – 9 ] and large cell carcinoma (~ 5–10%) [ 9 ]. Survival has improved for all subtypes in recent years, but the extent of improvement has been higher for adenocarcinoma than squamous tumors [ 10 ]. Recurring mutations have been reported in genes coding for epidermal growth factor receptors (EGFR) in 10–40% of adenocarcinomas [ 11 – 13 ], but these mutations are rare in squamous tumors [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Erlotinib treatment after platinum-based therapy in elderly patients with non-small-cell lung cancer in routine clinical practice – results from the ElderTac study

Brueckl

Achenbach²,

Ficker

et al. 2018

BMC Cancer

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BackgroundIn this prospective non-interventional study, the effectiveness and tolerability of erlotinib in elderly patients with non-small-cell lung cancer (NSCLC) after ≥1 platinum-based chemotherapy were assessed.MethodsA total of 385 patients ≥65 years of age with advanced NSCLC receiving erlotinib were observed over 12 months. The primary endpoint was the 1-year overall survival (OS) rate.ResultsPatients were predominantly Caucasian (99.2%), a mean of 73 years old; 24.7% had an Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2. Most common tumor histologies were adenocarcinoma (64.9%) and squamous cell carcinoma (22.3%). Of 119 patients tested, 15.1% had an activating epidermal growth factor receptor gene (EGFR) mutation. The 1-year OS rate was 31% (95% CI 25–36) with a median OS of 7.1 months (95% CI 6.0–7.9). OS was significantly better in females than males (p = 0.0258) and in patients with an EGFR mutation compared to EGFR wild-type patients (p = 0.0004). OS was not affected by age (p = 0.3436) and ECOG PS (p = 0.5364). Patients with squamous NSCLC tended to live longer than patients with non-squamous EGFR wild-type tumors (median OS: 8.6 vs 5.5 months). Cough and dyspnea improved during the observation period. The erlotinib safety profile was comparable to that in previous studies with rash (45.2%) and diarrhea (22.6%) being the most frequently reported adverse events.ConclusionsErlotinib represents a suitable palliative treatment option in further therapy lines for elderly patients with advanced NSCLC. The results obtained under real-life conditions add to our understanding of the benefits and risks of erlotinib in routine clinical practice.Trial registrationBfArM (https://www.bfarm.de; ML23023); ClinicalTrials.gov (NCT01535729; 20 Feb 2012).

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Section: Discussioncontrasting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Erlotinib treatment after platinum-based therapy in elderly patients with non-small-cell lung cancer in routine clinical practice – results from the ElderTac study

Brueckl

Achenbach²,

Ficker

et al. 2018

BMC Cancer

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“…Similarly, oligometastatic disease may be associated with a longer survival compared with extensive cancer discovered when debilitating symptoms occur . Second, we observed more adenocarcinomas and fewer neuroendocrine and small cell cancers among patients with myeloma, suggesting a higher incidence of tumors with epidermal growth factor receptor mutations or other favorable genomic lesions . Hypothetically, differences in histology may relate to varying rates of tobacco use or to alterations in immune surveillance, which is an area of increasing importance in thoracic oncology .…”

Section: Discussionmentioning

confidence: 73%

“…30 Second, we observed more adenocarcinomas and fewer neuroendocrine and small cell cancers among patients with myeloma, suggesting a higher incidence of tumors with Cancer February 15, 2019 epidermal growth factor receptor mutations or other favorable genomic lesions. 31 Hypothetically, differences in histology may relate to varying rates of tobacco use or to alterations in immune surveillance, which is an area of increasing importance in thoracic oncology. 32 It is interesting to note that similar associations in patients with lung cancer were observed among those with Waldenstrom macroglobulinemia, who had similar OS (HR, 1.17; P = .11) but better CSS (HR, 0.73; P = .02) than controls.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of secondary solid tumor malignancies among patients with myeloma: A population‐based study

Barth

Castillo

Olszewski

2018

Cancer

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Background Therapeutic advances have extended survival for patients with myeloma, who may develop secondary cancers. Methods Using the population‐based Surveillance, Epidemiology, and End Results registry (2004‐2015), the authors examined the characteristics, overall and cause‐specific survival, and cumulative incidence function of cancer‐related death among patients with myeloma with secondary cancers of the breast, prostate, lung, colon/rectum, or bladder or melanoma. Each patient was matched based on age, sex, race, and year of diagnosis to 50 controls from a general population who were diagnosed with the index cancer. Results Patients with myeloma with breast, prostate, or lung cancer were more commonly diagnosed at an early stage, whereas the stage distribution did not differ significantly among patients with melanoma, colorectal cancer, or bladder cancer. For all studied cancers except those of the lung, overall mortality was significantly higher among patients with myeloma compared with controls (hazard ratios, 1.84‐2.81). However, the cumulative incidence function of cancer‐related death did not differ (subhazard ratios, 0.84‐0.99) and was surpassed by myeloma‐related deaths (23% to 35% at 5 years). In patients with lung cancer, cancer‐related mortality was uniquely lower among patients with myeloma (subhazard ratio, 0.59; 95% confidence interval, 0.52‐0.68), even after adjustment for stage of disease. There was no significant difference noted with regard to noncancer deaths for any studied solid tumor. Use of surgery (evaluated in patients with nonmetastatic tumors, and in addition matched by disease stage) did not differ between cases and controls, except for fewer prostatectomies being noted among patients with myeloma (odds ratio, 0.56; 95% confidence interval, 0.42‐0.74). Conclusions The results of the current study support curative treatment approaches to secondary cancers among patients with myeloma while highlighting the need for ongoing active myeloma management.

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“…One of the pitfalls of analyzing aggregate results of patient-level data over a 20-year period may be that the impact of innovation on small subgroups of patients who have achieved greatest benefit could have been diluted in the aggregate analysis. Thus, our aggregated long-term analysis may be masking higher improvement in the 1-year OS of patients diagnosed with adenocarcinoma as compared to those with squamous-cell carcinoma, as demonstrated by Olszewski et al [31].…”

Section: Plos Onementioning

confidence: 72%

Retrospective observational cohort study on innovation in oncology and progress in survival: How far have we gotten in the two decades of treating patients with advanced non-small cell lung cancer as a single population?

Justo

Nilsson²,

Korytowsky

et al. 2020

PLoS ONE

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We assessed the impact of new antineoplastic agents on the overall survival (OS) of advanced non-small cell lung cancer (aNSCLC) patients followed up until 2012. Multivariate regression models were run for OS (outcome) and four proxies for innovation (exposure): Index (InnovInd, for SEER-Research data 1973-2012) and three levels of aggregation of Mean Medication Vintage, i.e. Overall (MMV Overall), using data aggregated at the State Level (MMV State), and using patient-level data (MMV Patient) using data from the US captured in SEER-Medicare 1991-2012. We derived Hazard ratios (HR) from Royston-Parmar models and odds ratios (OR) from a logistic regression on 1-year OS. Including 164,704 patients (median age 72 years, 56.8% stage IV, 61.8% with no comorbidities, 37.8% with adenocarcinoma, 22.9% with squamous-cell, 6.1% were censored). One-year OS improved from 0.22 in 1973 to 0.39 in 2012, in correlation with InnovInd (r = 0.97). Ten new NSCLC drugs were approved and 28 more used off-label. Regression-models results indicate that therapeutic innovation only marginally reduced the risk of dying (HROverall = 0.98 [0.98-0.98], HR MMV-Patient = 0.98 [0.97-0.98], and HR MMV-State = 0.98 [0.98-0.98], and slightly improved 1-year survival (OR MMV-Overall = 1.05 95%CI [1.04-1.05]). These results were validated with data from the Swedish National Health Data registers. Until 2013, aNSCLC patients were treated undifferentiated and the introduction of innovative therapies had statistically significant, albeit modest, effects on survival. Most treatments used off-guidelines highlight the high unmet need; however new advancements in treatment may further improve survival.

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Survival Trends in Histologic Subtypes of Metastatic Non-Small Cell Lung Cancer (mNSCLC) in the United States: 2000-2010

Cited by 8 publications

References 0 publications

Erlotinib treatment after platinum-based therapy in elderly patients with non-small-cell lung cancer in routine clinical practice – results from the ElderTac study

Erlotinib treatment after platinum-based therapy in elderly patients with non-small-cell lung cancer in routine clinical practice – results from the ElderTac study

Outcomes of secondary solid tumor malignancies among patients with myeloma: A population‐based study

Retrospective observational cohort study on innovation in oncology and progress in survival: How far have we gotten in the two decades of treating patients with advanced non-small cell lung cancer as a single population?

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