The Impact of Immunotherapy Use in Stage IIIA (T1-2N2) NSCLC: A Nationwide Analysis

Lye-Yeng Wong, MD; Douglas Z. Liou, MD; Mohana Roy, MD; Irmina A. Elliott, MD; Leah M. Backhus, MD; Natalie S. Lui, MD; Joseph B. Shrager, MD; Mark F. Berry, MD

JTO Clinical and Research Reports (Mar 2024)

The Impact of Immunotherapy Use in Stage IIIA (T1-2N2) NSCLC: A Nationwide Analysis

Lye-Yeng Wong, MD,
Douglas Z. Liou, MD,
Mohana Roy, MD,
Irmina A. Elliott, MD,
Leah M. Backhus, MD,
Natalie S. Lui, MD,
Joseph B. Shrager, MD,
Mark F. Berry, MD

Affiliations

Lye-Yeng Wong, MD: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California; Corresponding author. Address for correspondence: Lye-Yeng Wong, MD, Falk Cardiovascular Research Institute, 300 Pasteur Drive, Stanford, CA 94305.
Douglas Z. Liou, MD: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California
Mohana Roy, MD: Department of Medical Oncology, Stanford University Medical Center, Stanford, California
Irmina A. Elliott, MD: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California; Department of Cardiothoracic Surgery, VA Palo Alto Health Care System, Palo Alto, California
Leah M. Backhus, MD: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California; Department of Cardiothoracic Surgery, VA Palo Alto Health Care System, Palo Alto, California
Natalie S. Lui, MD: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California
Joseph B. Shrager, MD: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California; Department of Cardiothoracic Surgery, VA Palo Alto Health Care System, Palo Alto, California
Mark F. Berry, MD: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California

Journal volume & issue: Vol. 5, no. 3
p. 100654

Abstract

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Introduction: Multiple clinical trials have revealed the benefit of immunotherapy (IO) for NSCLC, including unresectable stage III disease. Our aim was to investigate the impact of IO use on treatment and outcomes of potentially resectable stage IIIA NSCLC in a broader nationwide patient cohort. Methods: We queried the National Cancer Database (2004–2019) for patients with stage IIIA (T1-2N2) NSCLC. Treatment and survival were evaluated with descriptive statistics, logistic regression, Kaplan-Meier analysis, and Cox proportional hazards modeling. Results: Overall, 5.5% (3777 of 68,335) of patients received IO. IO use was uncommon until 2017, but by 2019, it was given to 40.1% (1544 of 2308) of stage IIIA patients. The increased use of IO after 2017 was associated with increased definitive chemoradiation treatment (54.2% [6800 of 12,535] from years 2017 to 2019 versus 46.9% [26,251 of 55,914] from 2004 to 2016, p < 0.001) and less use of surgery (18.1% [2266 of 12,535] from years 2017 to 2019 versus 22.0% [12,300 of 55,914] from 2004 to 2016, p < 0.001). IO treatment was associated with significantly better 5-year survival in the entire cohort (36.9% versus 23.4%, p < 0.001) and the subsets of patients treated with chemoradiation (37.2% versus 22.7%, p < 0.001) and surgery (48.6% versus 44.3%, p < 0.001). Pneumonectomy use decreased with increased IO treatment (5.1% of surgical patients [116 of 2266] from years 2017 to 2019 versus 9.2% [1127 of 12,300] from 2004 to 2016, p < 0.001). Conclusions: Increased use of IO was associated with a change in treatment patterns and improved survival for patients with stage IIIA(N2) NSCLC.

Published in JTO Clinical and Research Reports

ISSN: 2666-3643 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jto-clinical-and-research-reports/

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