1372P - Advanced non-small cell lung carcinoma in the era of immunotherapy: Survival and the risk of multiple primary malignancies

Background

NSCLC (Non-Small Cell Lung Carcinoma) is 85% of lung cancer incidence and remains an incurable disease for most patients. The incorporation of new immunotherapy is promising but its role in patients with advanced disease is unclear. This study looks at the survival and multiple primary malignancies of patients treated with immunotherapy and standard chemo radiotherapy, aiming to understand the most effective management that will prolong patient survival and quality of life.

Methods

The Surveillance, Epidemiology, and End Results (SEER) 8.4.3 program was used to obtain data. Patients aged 0-85 with NSCLC were included from 2010-2015 for the standard therapy arm, and 2015-2020 for the immunotherapy arm. Relative Survival (RS) was compared using Kaplan Meier, Log-rank analysis. The standardized incidence ratio (SIR) was obtained as observed/expected (O/E), considered significant if P<0.05, Excess Absolute Risk (EAR) per 10,000, and 95% confidence interval (CI). BM SPSS Statistics 27.0.1 was used to conduct the statistical analysis.

Results

We identified 14,688 patients in total, 70% were treated without immunotherapy, and 30% were treated with immunotherapy. Patients treated with immunotherapy showed better overall survival (95%CI 2.92 - 3.07, P<0.05%), and the 1-, 3-year RS was 12.7%, and 3.7% respectively. Patients with bone metastasis had the best observed survival when treated with immunotherapy, and the worst survival when treated with standard therapy (95%CI 2.86 - 3.13, P<0.05%). The immunotherapy treatment arm had low risk of developing multiple primary malignancy with O/E=1.89 (95% CI=1.84 -1.93, EAR=132.75, P<0.05%), while the standard treatment arm showed higher risk of developing multiple primary malignancy with O/E=2.25 (95% CI=2.09 - 2.42, EAR=214.6, P<0.05%), specifically adrenal gland malignancy.

Conclusions

Immunotherapy has proven its great value in increasing survival of advanced NSCLC and decreasing the risk of developing multiple primary malignancy. Patients with bone metastasis should be indicated for immunotherapy instead of standard therapy, while patients on standard therapy should be screened for other primary malignancies, including adrenal and other endocrine tumours.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.