An Observational Study on Treatment Outcomes in Patients With Stage III NSCLC in Taiwan: The KINDLE Study

Po-Lan Su, MD; Gee-Chen Chang, MD; Shih-Hsin Hsiao, MD; Te-Chun Hsia, MD; Meng-Chih Lin, MD; Min-Hsi Lin, MD; Jin-Yuan Shih, MD; Cheng-Ta Yang, MD; Sheng-Hsiung Yang, MD; Yuh-Min Chen, MD, PhD

JTO Clinical and Research Reports (Mar 2022)

An Observational Study on Treatment Outcomes in Patients With Stage III NSCLC in Taiwan: The KINDLE Study

Po-Lan Su, MD,
Gee-Chen Chang, MD,
Shih-Hsin Hsiao, MD,
Te-Chun Hsia, MD,
Meng-Chih Lin, MD,
Min-Hsi Lin, MD,
Jin-Yuan Shih, MD,
Cheng-Ta Yang, MD,
Sheng-Hsiung Yang, MD,
Yuh-Min Chen, MD, PhD

Affiliations

Po-Lan Su, MD: Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Gee-Chen Chang, MD: Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
Shih-Hsin Hsiao, MD: Division of Pulmonary Medicine, Department of Internal Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Te-Chun Hsia, MD: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Respiratory Therapy, China Medical University, Taichung, Taiwan
Meng-Chih Lin, MD: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Min-Hsi Lin, MD: Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Jin-Yuan Shih, MD: Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
Cheng-Ta Yang, MD: Department of Thoracic Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
Sheng-Hsiung Yang, MD: Division of Chest Medicine, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
Yuh-Min Chen, MD, PhD: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Corresponding author. Address for correspondence: Prof. Yuh-Min Chen, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, Number 201, Sector 2, Shipai Road, Beitou District, Taipei City, Taiwan.

Journal volume & issue: Vol. 3, no. 3
p. 100292

Abstract

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Introduction: Patients with stage III NSCLC represent a very heterogenous group that requires different treatment strategies, especially in patients with N2 (2 nearby lymph nodes having cancer)-positive NSCLC and unresectable EGFR-mutant NSCLC. This real-world study may provide more insights into treatment decisions. Methods: The KINDLE study is a large, multinational real-world observational study that assessed different treatment strategies in patients with stage III NSCLC. Progression-free survival (PFS) and overall survival (OS) were estimated and compared using Kaplan-Meier and log-rank testing. Patients were classified on the basis of disease stage, resectability, and treatment modalities. Results: The Taiwan subgroup enrolled 200 patients. The median PFS and OS values were similar among patients with stage IIIA and stage IIIB disease, but were significantly better in patients who were deemed as a resectable disease than in those who were deemed as an unresectable disease. In patients with N2-positive NSCLC, patients who underwent surgery had better PFS, but not OS, than patients administered with chemoradiotherapy (CRT) (PFS 13.4 vs. 7.3 mo, hazard ratio [HR] = 0.18, p < 0.001; OS 32.4 vs. 22.0 mo, HR = 0.64, p = 0.215). Among patients with unresectable EGFR-mutant NSCLC, OS was significantly poorer after upfront EGFR–tyrosine kinase inhibitors (TKI) than after upfront CRT with sequential EGFR-TKI (27.4 vs. 49.0 mo, HR = 3.09, p = 0.03). Conclusions: Our study suggests that surgery could be added as part of therapy for patients with stage III N2-positive NSCLC. Moreover, upfront CRT with sequential EGFR-TKI seems to be appropriate for stage III unresectable EGFR-mutant NSCLC. Further randomized studies are needed to validate these results.

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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