Real-world clinical practice and outcomes in treating stage III non-small cell lung cancer: KINDLE-Asia subset

Kumar Prabhash; Daniel Shao Weng Tan; Ross A Soo; Piyada Sitthideatphaiboon; Yuh Min Chen; Pei Jye Voon; Elisna Syahruddin; Sojung Chu; Reto Huggenberger; Byoung-Chul Cho

doi:10.3389/fonc.2023.1117348

Real-world clinical practice and outcomes in treating stage III non-small cell lung cancer: KINDLE-Asia subset

Front Oncol. 2023 Mar 27:13:1117348. doi: 10.3389/fonc.2023.1117348. eCollection 2023.

Authors

Affiliations

¹ Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
² Division of Medical Oncology, National Cancer Centre, Singapore, Singapore.
³ Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.
⁴ Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
⁵ Taipei Veterans General Hospital, School of Medicine, National Yang-Ming Medical University, Taipei City, Taiwan.
⁶ Department of Radiotherapy and Oncology, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia.
⁷ Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan Hospital, Jakarta, Indonesia.
⁸ Medical Affairs, AstraZeneca, Seoul, Republic of Korea.
⁹ Medical Affairs, AstraZeneca, Baar, Switzerland.
¹⁰ Division of Medical Oncology, Yonsei Cancer Centre, Yonsei University College of Medicine, Seoul, Republic of Korea.

Abstract

Introduction: Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease requiring multimodal treatment approaches. KINDLE-Asia, as part of a real world global study, evaluated treatment patterns and associated survival outcomes in stage III NSCLC in Asia.

Methods: Retrospective data from 57 centers in patients with stage III NSCLC diagnosed between January 2013 and December 2017 were analyzed. Median progression free survival (mPFS) and median overall survival (mOS) estimates with two sided 95% confidence interval (CI) were determined by applying the Kaplan-Meier survival analysis.

Results: Of the total 1874 patients (median age: 63.0 years [24 to 92]) enrolled in the Asia subset, 74.8% were men, 54.7% had stage IIIA disease, 55.7% had adenocarcinoma, 34.3% had epidermal growth factor receptor mutations (EGFRm) and 50.3% had programmed death-ligand 1 (PD-L1) expression (i.e. PD-L1 ≥1%). Of the 31 treatment approaches as initial therapy, concurrent chemoradiotherapy (CRT) was the most frequent (29.3%), followed by chemotherapy (14.8%), sequential CRT (9.5%), and radiotherapy (8.5%). Targeted therapy alone was used in 81 patients of the overall population. For the Asia cohort, the mPFS and mOS were 12.8 months (95% CI, 12.2-13.7) and 42.3 months (95% CI, 38.1-46.8), respectively. Stage IIIA disease, Eastern Cooperative Oncology Group ≤1, age ≤65 years, adenocarcinoma histology and surgery/concurrent CRT as initial therapy correlated with better mOS (p < 0.05).

Conclusions: The results demonstrate diverse treatment patterns and survival outcomes in the Asian region. The high prevalence of EGFRm and PD-L1 expression in stage III NSCLC in Asia suggests the need for expanding access to molecular testing for guiding treatment strategies with tyrosine kinase inhibitors and immunotherapies in this region.

Keywords: EGFR mutation; adenocarcinoma; concurrent chemoradiotherapy (CCRT); lung cancer; stage III NSCLC; targeted therapy.