Proportion of Untreated Stage III-IV Lung Cancers Increasing

The proportion of patients with untreated stage IIIA or IV non-small cell lung cancer (NSCLC) is rising despite superior outcomes associated with treatment, according to a study published in the Journal of Thoracic Oncology.¹

Hypothesizing that there are a substantial proportion of untreated patients who are similar to those who undergo therapy, researchers evaluated treatment trends and their association with clinical outcomes for NSCLC.

Investigators analyzed data from patients with primary NSCLC included in the National Cancer Data Base from 1998 to 2012. Of those, 190,539 (21%) received no treatment. The proportion of patients with stage IIIA NSCLC or stage IV disease increased over the study period by 0.21% (P = .003) and 0.4% (P < .0001), respectively.

Untreated patients had significantly shorter overall survival than those who received treatment irrespective of stage (P < .0001).

Researchers matched 6144 patients with stage IIIA disease who received chemoradiotherapy with patients who received no treatment. The analysis demonstrated significantly shorter overall survival for untreated patients, with a median survival of 16.5 months for treated patients and 6.1 months for untreated patients (P < .0001).

Among 19,046 patient pairs with stage IV disease treated with chemotherapy vs no treatment, median overall survival was 9.3 months and 2.0 months, respectively (P < .0001).

Despite limitations to fully account for heterogeneity and selection bias, the study highlights a substantial proportion of untreated patients with advanced NSCLC. Future studies are needed to evaluate innovative strategies to improve access to care for patients with NSCLC.

Reference

1. David EA, Daly ME, Li CS, et al. Increasing rates of no treatment in advanced-stage non–small cell lung cancer patients: A propensity-matched analysis. J Thorac Oncol. 2017 Jan 18. doi: 10.1016/j.jtho.2016.11.2221 [Epub ahead of print]