372P - Treatment patterns and outcomes in stage III non-small cell lung cancer (NSCLC): Real-world experience in Singapore from the KINDLE study

Background

Stage III NSCLC, a heterogeneous disease with poor prognosis despite multimodal treatment, warrants study of treatment patterns. The patterns and survival outcomes in real-world pre-immuno-oncology (IO) era in Singapore were studied.

Methods

Retrospective data were collected from 3 centers (part of the KINDLE observational study) on patients diagnosed with stage III NSCLC between 01JAN2013 and 31DEC2017, with at least 9 months (m) of available records. Descriptive and inferential statistics were used to analyze clinico-demographics, treatment patterns, and their correlation with progression free survival (PFS) and overall survival (OS).

Results

Characteristics for 210 patients: median age 63 years (range 36-86), 72.4% men, 65.7% ever smoked, 61.8% with stage IIIA NSCLC (AJCC 7th ed.), and 90.9% with ECOG score of 0/1. Histology types were adenocarcinoma (61.4%) and squamous cell carcinoma (24.8%); 43.3 % had EGFR mutations. Of the 17 first-line regimens, predominant were concurrent chemoradiotherapy (cCRT, 31.2%), radiotherapy (12.9%), and sequential CRT (sCRT, 6.9%). Median PFS was 11.5m, 95% confidence interval (CI) 9.33-13.86 (14.3m [IIIA] vs 6.5m [IIIB], hazards ratio [HR] 0.553, p=0.0002); median OS was 26.3m, 95%CI 22.80-37.09 (40.7m [IIIA] vs 17.1m [IIIB], HR 0.515, p=0.0002). cCRT (HR 0.621, p=0.003) and surgery (HR 0.485, p=0.002) were associated with longer PFS and OS, respectively. In stage IIIA, surgery+CT (p=0.03) and cCRT (p=0.004) were associated with longer OS than CT alone; cCRT was associated with better OS than EGFR-TKI (p =0.044) in all stage IIIA and in unresectable stage IIIA and IIIB with EGFR mutations. In stage IIIB, cCRT (p<0.0001), sCRT (p=0.015), and EGFR-TKI (p=0.040) were associated with longer OS than RT alone; cCRT was associated with longer OS than CT alone (p=0.0014). With cCRT, median OS for unresectable stage IIIA and IIIB was 50.8m in EGFR+ and 25m in EGFR-.

Conclusions

Similar to the main KINDLE study, this subset reveals varied treatment practices for stage III NSCLC. Poor OS with existing treatment patterns reiterates the unmet medical need of the pre-IO era. This calls for improved access to newer medicines and quality care.

Clinical trial identification

D133HR00004.

Editorial acknowledgement

Legal entity responsible for the study

AstraZeneca.

Funding

AstraZeneca.

Disclosure

A. Kumar, R. Huggenberger, S. Robb: Full/Part-time employment: AstraZeneca. All other authors have declared no conflicts of interest.