Patients With Stage 4 NSCLC at Diagnosis Tend to Have Poorer Outcomes

A recent study, with information from the National Lung Screening Trial (NLST) and Stanford Healthcare (SHC) concluded that patients with distant recurrent metastatic non-small cell lung cancer (NSCLC) tended to have improved survival in comparison with de novo stage 4 disease. The study also investigated characteristics in correlation to overall survival that may impact it’s results. These finding were published in JAMA Network.

Of note, distant recurrent metastatic disease occurs when a patient is diagnosed with and treated for NSCLC, which then returns or spreads in an area outside of the lung. Meanwhile, de novo stage 4 disease is when patients already have metastases at the time of their diagnosis.

The study consisted of 660 patients in the NLST group and 180 in the SHC group, all being followed for seven years. Within the group of patients with distant recurrences, the median three-year overall survival was 21.7% (meaning that three years after the start of the study, 21.7% of patients were still alive) compared to 10.5% within patients in the de novo disease group.

“These findings suggest metastatic disease type as a factor associated with outcomes could be considered in future clinical trial design to ensure a balance for baseline patient characteristics,” the investigators wrote.

The difference in overall survival continued once researchers regulated characteristics such as age, sex, race, histologic findings and smoking status, according to study author, Chloe C. Su, a PhD student in epidemiology and clinical research at Stanford.

Data from the study also concluded that patients in the de novo group more frequently experienced progression to the bone or pleura compared, to patients with distant recurrence. Alongside this, de novo disease was found based on symptoms, which concluded a potentially greater amount of cancer at the time of their diagnoses. Distant recurrences were discovered through checkups after treatment occurred.

Findings from the SHC group showed that patients with distant recurrences showed a 36% decreased risk of death in comparison to the de novo group. Researchers believe that this could be due to early findings of metastatic disease within patients with distant recurrences due to CT surveillance.

Factors such as tumor burden (the total number of cancerous cells in a body) and cancer spreading to the pleura and bone can also contributor to survival outcomes.

“This factor associated with outcomes may have important implications in future clinical trials and cost-effectiveness analyses, and the treatment effectiveness for patients with metastatic NSCLC warrants further evaluation,” the study authors wrote.

Dr. Lauren Averett Byers, associate professor of thoracic/head and neck medical oncology at The University of Texas MD Anderson Cancer Center in Houston, discussed that understanding the nature of metastatic disease as a whole is impactful within these patient populations.

“Whenever we’re trying to design a clinical trial, we always want to think about ‘What are some of the different aspects within a patient group that could impact differences between patients?. The data are helpful in possible approaches to subset analyses or, at the very least, suggest that patients with de novo stage IV disease may experience different outcomes compared with those who received treatment for an initial stage and subsequently faced a recurrence,” she noted.

Byers also revealed the limitations within the study, alongside the importance of diligent and cautious examination of the study’s results.

“It is important that future research broaden the understanding of metastatic lung cancer, including the involvement of diverse patient groups for enhanced insights into treatment outcomes,” she added. It can be challenging to interpret analyses that are only conducted in a select portion of lung cancers, she noted. “I think that (the study) may, again, be very useful, but you want to interpret it with caution, and there may be a need for further analysis in larger groups of patients with metastatic disease.”

For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.