Abstract 90P
Background
Evidence based on clinical trials has shown a very good correlation between DFS and OS in completely resected NSCLC patients (pts) with adjuvant therapy. This study assessed the relationship between DFS and OS in real-world pts and disease burden associated with recurrence.
Methods
This retrospective study used data from the ConcertAI Patient360™ database, primarily drawn from United States community oncology practices. DFS was defined as time from complete resection to earliest of first recurrence (locoregional or distant recurrence based on provider notes or new diagnosis of other primary cancer) or death. OS from recurrence in pts with recurrence was compared with OS from a comparable time point in pts without recurrence using Kaplan-Meier analyses and Cox models. OS after landmark points was also compared between pts with and without recurrence by the landmark point. Monthly healthcare resource utilization (HCRU) was compared between the two cohorts using generalized linear models.
Results
The study included 441 pts with completely resected stage IB-IIIA NSCLC (stage IB: 35%, stage II: 42%; stage IIIA: 24%). Median age at initial diagnosis was 67 years. Similar baseline characteristics were observed for the two cohorts (240 pts with recurrence and 201 without). Pts with recurrence had significantly shorter OS compared to those without (median 31.4 vs. 75.6 months; hazard ratio [HR], 95% confidence interval [CI]: 2.46, 1.81-3.34), and a strong association of recurrence with shorter OS was present even at time points 5 years or later after resection (Table). Pts with recurrence had more monthly follow-up office visits (Incidence Rate Ratio [IRR]=2.21) and hospitalizations (IRR=3.62) (All p<0.0001). Table: 90P
Cox proportional hazard model results of OS between patients with and without recurrence by each landmark point after 1, 3, 5, and 7 years following complete resection
| Landmark Point (years following complete resection) | Median OS after landmark point, months | Adjusted HR* (95% CI) | P-value | |
| With recurrence by landmark point | Without recurrence by landmark point | |||
| 1 | 29.1 | 83.4 | 4.23 (2.85, 6.26) | <0.0001 |
| 3 | 35.7 | 75.6 | 4.47 (3.04, 6.58) | <0.0001 |
| 5 | 31.3 | 64.7 | 3.04 (1.84, 5.02) | <0.0001 |
| 7 | 24.5 | 58.3 | 5.40 (2.30, 12.70) | 0.0001 |
*Disease stage, age, gender, race, individual comorbid conditions, baseline HCRU, and use of adjuvant chemotherapy were adjusted in the Cox model.
Conclusions
Based on data from an era preceding peri-operative targeted therapy or immunotherapy, recurrence post complete resection is associated with worse survival outcomes and higher HCRU, even many years out from surgery.
Legal entity responsible for the study
ConcertAI.
Funding
Merck & Co., Inc.
Disclosure
H. West: Financial Interests, Personal, Other, Consultant: Amgen; Financial Interests, Personal, Speaker’s Bureau: AstraZeneca; Financial Interests, Personal, Other, Consultant: AstraZeneca; Financial Interests, Personal, Other, Consultant: Eli Lilly; Financial Interests, Personal, Speaker’s Bureau: Genentech/Roche; Financial Interests, Personal, Other, Consultant: Genentech/Roche; Financial Interests, Personal, Advisory Board: Merck & Co., Inc.; Financial Interests, Personal, Other, Consultant: Merck & Co., Inc.; Financial Interests, Personal, Other, Consultant: Mirati; Financial Interests, Personal, Other, Consultant: Pfizer; Financial Interests, Personal, Other, Consultant: Regeneron. X. Hu: Financial Interests, Personal, Full or part-time Employment: MSD, Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA; Financial Interests, Personal, Stocks/Shares: Merck & Co., Inc., Kenilworth, NJ, USA. T. Burke: Financial Interests, Personal, Full or part-time Employment: MSD, Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA ; Financial Interests, Personal, Stocks/Shares: Merck & Co., Inc., Kenilworth, NJ, USA. M.S. Walker: Financial Interests, Institutional, Funding: Merck & Co., Inc.; Financial Interests, Personal, Full or part-time Employment: ConcertAI. Y. Wang: Financial Interests, Institutional, Funding: Merck & Co., Inc.; Financial Interests, Personal, Full or part-time Employment: ConcertAI. A. Samkari: Financial Interests, Personal, Full or part-time Employment: MSD, Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA ; Financial Interests, Personal, Stocks/Shares: Merck & Co., Inc., Kenilworth, NJ, USA.