Real-world treatment patterns and clinical outcomes in patients with stage III non-small cell lung cancer: results of KINDLE-Egypt cohort

Rasha Aboelhassan; Mohamed Emam Sobeih; Mohamed Alm El-Din; Ramy R Ghali; Ibtessam Saad El-Din; Ola Khorshid; Mohsen Mokhtar; Ahmed Magdy Rabea; Abdelaziz Belal; Hamdy A Azim; Mohamed Abdullah; Tamer Elnahas; Hesham Tawfik; Sherif Abdelwahab; Amr Abdelaziz Elsaid; Tarek Hashem; Mohamed Mancy; Heba Farag

doi:10.1177/17588359231212182

Real-world treatment patterns and clinical outcomes in patients with stage III non-small cell lung cancer: results of KINDLE-Egypt cohort

Ther Adv Med Oncol. 2023 Nov 22:15:17588359231212182. doi: 10.1177/17588359231212182. eCollection 2023.

Authors

Rasha Aboelhassan¹, Mohamed Emam Sobeih², Mohamed Alm El-Din³, Ramy R Ghali⁴, Ibtessam Saad El-Din⁵, Ola Khorshid², Mohsen Mokhtar⁵, Ahmed Magdy Rabea², Abdelaziz Belal⁶, Hamdy A Azim⁵, Mohamed Abdullah⁵, Tamer Elnahas⁵, Hesham Tawfik³, Sherif Abdelwahab⁴, Amr Abdelaziz Elsaid⁶, Tarek Hashem^{7

8}, Mohamed Mancy⁹, Heba Farag⁹

Affiliations

¹ Nasser Institute for Research and Treatment, Egypt.
² National Cancer Institute, Cairo University, Cairo, Egypt.
³ Tanta University, Tanta, Egypt.
⁴ Ain Shams University, Cairo, Egypt.
⁵ Cairo University, Cairo, Egypt.
⁶ Alexandria University, Alexandria, Egypt.
⁷ Menofia University, Shebin EL-koum, Cairo, Egypt.
⁸ Armed Forces College of Medicine, Heliopolis, Cairo, Egypt.
⁹ AstraZeneca, Cairo, Egypt.

Abstract

Background: Stage III non-small cell lung cancer (NSCLC) being highly heterogeneous requires multimodal therapeutic strategies for optimal management. We present findings on treatment patterns and their associated survival outcomes in patients with stage III NSCLC from the Egypt subset of the KINDLE global real-world study conducted across countries from Asia, Middle East, Africa, and Latin America.

Method: Retrospective data from the Egypt subset (21 centers) of adult patients diagnosed with stage III NSCLC between January 2013 and December 2017 were analyzed. Descriptive and inferential statistics summarized treatment modalities, progression-free survival (PFS), and overall survival (OS).

Results: Of 421 patients enrolled (median age: 59.0 years), 77.9% were males, 53.5% had stage IIIA disease, 60.8% had adenocarcinoma, 78.4% had an unresectable disease, and 81.5% had Eastern Cooperative Oncology Group performance status ⩽1. Overall, chemotherapy alone (40.4%) was predominantly used in the initial line, whereas definite radiotherapy was used in only 5.0% of patients. In resectable patients, chemotherapy plus surgery (33.8%), surgery alone (20.6%), or other surgery (20.6%) were the top three modalities used in initial line of treatment. Chemotherapy alone was most preferred (48.8%) in unresectable patients, followed by sequential chemoradiotherapy (CRT) (17.6%) and concurrent CRT (9.3%). The overall median PFS was 10.3 months [95% confidence interval (CI), 9.43-12.02], whereas the median OS was 18.5 months (95% CI, 16.46-21.88). Overall, female gender, adenocarcinoma histology, and radical therapy as surgery or CRT predicted significantly longer OS (all p < 0.05).

Conclusion: KINDLE-Egypt cohort revealed wide heterogeneities in the treatment patterns of stage III NSCLC. Although deemed resectable, few patients did not undergo surgery, probably due to high smoking rates leading to poor lung function. Lower survival outcomes than other published real-world studies highlight the need for timely approval and availability of novel targeted and immunotherapies to enhance patient outcomes.

Trial registration: NCT03725475.

Keywords: adenocarcinoma; concurrent chemoradiotherapy; epidermal growth factor receptor mutation; lung cancer; stage III NSCLC; targeted therapy.

Associated data

ClinicalTrials.gov/NCT03725475