136MO - Predictors of multidisciplinary tumor board adherence in stage III non-small cell lung cancer patients from a large multicenter study

Background

While formalized treatment recommendations for NSCLC by a multidisciplinary tumor board (MDT) has been associated with improved patient care, there is no data on the prognostic impact of individual adherence to initial MDT treatment recommendations in patients (pts) with stage III NSCLC.

Methods

Multimodal treatment data for stage III (UICC/AJCC 8th TNM staging edition) NSCLC pts between 2014 and 2020 were collected from 3 Swiss referral centers. All pts underwent MDT before treatment. MDTadherence was defined as implementation of initially recommended treatment including surgery, radiotherapy (RT), systemic treatment including sequence and intensity. Event-free survival (EFS) and overall survival (OS) were subjected to Kaplan-Meier analysis. MDT adherence was subjected to multivariable Cox regression analysis including established prognostic factors.

Results

Adherence to initial MDT recommendations was found in 385/547 (70.4%) eligible pts. Treatment de-escalation was the prominent feature in 109/162 (67.3%) non-MDT-adherent pts, including inoperability after upfront chemotherapy (34.6%) or neoadjuvant chemoradiotherapy (15.4%) and inability to apply curative RT (17.3%). This resulted in 89/547 (16.3%) pts receiving non-curative treatment. Pts ≥65 years of age had an increased risk for MDT non-adherence (32.8% vs 23.0%, p=0.02), as had pts with a higher tumor stage (19.8% for IIIA, 38.5% for IIIB, 43.3% for IIIC, p < 0.001) and frail (ECOG ≥2) pts (53.7% vs 22.8%, p < 0.001). Median EFS was higher in MDT adherent pts (11.9 months vs 8.6 months (mo), p=0.003), as was OS (20.3 mo vs 9.4 mo, p < 0.001). OS was 20.6mo in stage IIIA, 14.9 mo in stage IIIB and 9.8 mo in stage IIIC. MDT non-adherence was an independent risk factor for EFS (hazard ratio (HR)=1.22, p=0.05). MDT non-adherence (HR=1.67, p < 0.001), disease stage (HR=1.24, p=0.02) and patient frailty (HR=1.59, p < 0.001) were independent risk factors for OS.

Conclusions

One third of stage III NSCLC pts is unable to adhere to initial MDT recommendations even in tertiary referral centers. Non-adherence was associated with worse outcome, and was most prominent in elderly and frail pts. Treatment strategies for vulnerable pts should critically be reviewed.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

M. Joerger: Financial Interests, Institutional, Invited Speaker, Clinical study activity: Basilea, Bayer, BMS, Immunophotonics, Innomedica, MSD, Novartis, Roche; Financial Interests, Institutional, Other, Clinical study activity: Daiichi Sankyo; Financial Interests, Institutional, Invited Speaker: Anaveon; Non-Financial Interests, Personal, Advisory Role: Novartis, AstraZeneca, Basilea, Bayer, BMS, Debiopharm, MSD, Roche, Sanofi. M.T. Mark: Financial Interests, Personal, Advisory Board: MSD, AstraZeneca, Janssen, Roche, Takeda; Financial Interests, Personal, Expert Testimony: BMS. I. Metaxas: Financial Interests, Institutional, Advisory Board: BMS, PharmaMar, Roche, Merck, AstraZeneca; Financial Interests, Institutional, Other, Travel expenses: Roche; Financial Interests, Institutional, Research Grant: BMS; Financial Interests, Institutional, Invited Speaker: PharmaMar. All other authors have declared no conflicts of interest.