Real-world treatment patterns and outcomes among patients with advanced non-small-cell lung cancer with spindle cell and/or giant cell carcinoma

Chia-Ling Chang; Min-Shu Hsieh; Jin-Yuan Shih; Yi-Hsuan Lee; Wei-Yu Liao; Chia-Lin Hsu; Ching-Yao Yang; Kuan-Yu Chen; Jih-Hsiang Lee; Chao-Chi Ho; Tzu-Hsiu Tsai; James Chih-Hsin Yang; Chong-Jen Yu

doi:10.1177/17588359221133889

Real-world treatment patterns and outcomes among patients with advanced non-small-cell lung cancer with spindle cell and/or giant cell carcinoma

Ther Adv Med Oncol. 2022 Oct 27:14:17588359221133889. doi: 10.1177/17588359221133889. eCollection 2022.

Authors

Chia-Ling Chang¹, Min-Shu Hsieh^{2

3}, Jin-Yuan Shih⁴, Yi-Hsuan Lee^{2

3}, Wei-Yu Liao^{5

4}, Chia-Lin Hsu⁴, Ching-Yao Yang⁴, Kuan-Yu Chen⁴, Jih-Hsiang Lee⁶, Chao-Chi Ho⁴, Tzu-Hsiu Tsai⁴, James Chih-Hsin Yang⁷, Chong-Jen Yu¹

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, and National Taiwan University College of Medicine.
² Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.
³ Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.
⁵ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung Shan South Road, Jhongjheng District, Taipei 100225.
⁶ Department of Oncology, National Taiwan University Hospital, Hsin-Chu Branch, and National Taiwan University College of Medicine.
⁷ Department of Oncology, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei.

Abstract

Objectives: A definitive diagnosis of pulmonary sarcomatoid carcinoma cannot be made with small biopsies. In clinical practice, a diagnosis of advanced non-small-cell lung cancer with spindle cell and/or giant cell carcinoma (NSCLCsg), or possible sarcomatoid carcinoma, is acceptable. Therefore, we aimed to investigate the treatment patterns and outcomes of advanced NSCLCsg.

Materials and methods: Between 01 January 2012 and 01 April 2021, patients with pathologically proven advanced NSCLCsg were enrolled. The choice of treatment was based on clinician discretion.

Results: In all, 101 patients with advanced NSCLCsg were enrolled. In total, 77 (76.2%) patients received at least one line of systemic therapy; 44 patients (43.1%) had received platinum doublet chemotherapy; 27 (26.7%) patients had been treated with targeted therapies; and 23 patients (22.8%) had been given an immune checkpoint inhibitor (ICI). The median overall survival (OS) was 6.3 months [95% confidence interval (CI): 3.6-9.0 months]. Excluding patients without systemic therapy, patients who had received an ICI had better OS (median: 18.2 months) than those who had not (median 3.8 months, log-rank test p = 0.002). No significant difference in OS was detected between patients who had or had not received platinum doublet chemotherapy (log-rank test p = 0.279), or targeted therapy (log-rank test p = 0.416). Having received any systemic therapy [hazard ratio (HR): 0.33, 95% CI: 0.18-0.61, p < 0.0001) and ICI (HR: 0.38, 95% CI: 0.19-0.78, p = 0.008) were independent factors for better OS. Patients with programmed death ligand-1 (PD-L1) expression ⩾50% had better OS than those with PD-L1 expression <50% (HR: 0.51, 95%: 0.30-0.86, p = 0.012).

Conclusion: Although advanced NSCLCsg has a poor survival outcome, our results showed that ICI may prolong OS in patients with advanced NSCLCsg. Further prospective studies are warranted to gain more understanding of the role of ICI in this specific patient population.

Keywords: immune checkpoint inhibitor; non-small-cell lung cancer with spindle cell and/or giant cell carcinoma; overall survival; programmed death ligand-1; pulmonary sarcomatoid carcinoma.