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Background <p>Advances in immunotherapy (IT) and targeted therapy have transformed treatment for stage IV non-squamous non-small cell lung cancer (NS-NSCLC). However, real-world data comparing modern regimens to previous standards remains limited. Herein, we aim to determine whether survival outcomes have improved with contemporary therapies,</p> Methods <p>We conducted a retrospective analysis of de novo stage IV NS-NSCLC at diagnosis treated at the Cleveland Clinic, OH, from 1/2010 to 12/2022. Baseline variables, including age, sex, race, performance status, smoking history, PD-L1 testing, and molecular profiling, were collected along with treatment regimens. Treatment responses were assessed. Overall survival (OS) and progression-free survival (PFS) were estimated. Multivariable Cox regression (CPH) was used to adjust for confounding.</p> Results <p>We identified 1,518 patients with NS-NSCLC, of which 97% had adenocarcinoma (<i>N</i> = 1,472). Median age was 65 (IQR 58–73); 51% were female, 82% white, and 42% current smokers. Treatments included conventional chemotherapy (CTX) (744, 49%), IT (186, 12%), CTX + IT (318, 21%), and targeted therapy (270, 18%). Common regimens were carboplatin + pemetrexed/paclitaxel (502, 80%) and bevacizumab + carboplatin + pemetrexed/paclitaxel (127, 20%) for CTX, pembrolizumab (167, 89%) for IT, and carboplatin + pemetrexed + pembrolizumab (153, 41%) for chemo-IT. Overall disease control rate was 58% with a median follow-up of 69.7 months. The 2- and 5-year OS were 30% and 12%, respectively. OS improved from 20% (2010–2012) to 38% (2019–2022) (<i>P</i> &lt; 0.05). Modern regimens were associated with a 23% reduced hazard of death (HR 0.77, 95% CI 0.66–0.90, <i>p</i> &lt; 0.001).</p> Conclusion <p>Modern regimens were associated with improved survival in stage IV NS-NSCLC, but long-term survival remains poor, underscoring the need for further research.</p>

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Trends in treatment and survival of stage IV non-squamous NSCLC from 2010 to 2022

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月31日

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  • Naveen Rehman,
  • Emily C. Zabor,
  • Aastha Dhakal,
  • Bridget Adcock,
  • Muaz Alsabbagh Alchirazi,
  • Moath Albliwi,
  • Ali Mushtaq,
  • Hadil Zureigat,
  • Monica Lee,
  • Ahmed Nabil Mohamed Hassan,
  • Heya Batah,
  • Preeyal Patel,
  • Meera Patel,
  • Sara Haddad,
  • Scott Robertson,
  • Michael Menefee,
  • Khaled Aref Hassan,
  • Marc A. Shapiro,
  • James Stevenson,
  • Alex A Adjei,
  • Lukas Delasos,
  • Moaath K. Mustafa Ali

摘要

Background

Advances in immunotherapy (IT) and targeted therapy have transformed treatment for stage IV non-squamous non-small cell lung cancer (NS-NSCLC). However, real-world data comparing modern regimens to previous standards remains limited. Herein, we aim to determine whether survival outcomes have improved with contemporary therapies,

Methods

We conducted a retrospective analysis of de novo stage IV NS-NSCLC at diagnosis treated at the Cleveland Clinic, OH, from 1/2010 to 12/2022. Baseline variables, including age, sex, race, performance status, smoking history, PD-L1 testing, and molecular profiling, were collected along with treatment regimens. Treatment responses were assessed. Overall survival (OS) and progression-free survival (PFS) were estimated. Multivariable Cox regression (CPH) was used to adjust for confounding.

Results

We identified 1,518 patients with NS-NSCLC, of which 97% had adenocarcinoma (N = 1,472). Median age was 65 (IQR 58–73); 51% were female, 82% white, and 42% current smokers. Treatments included conventional chemotherapy (CTX) (744, 49%), IT (186, 12%), CTX + IT (318, 21%), and targeted therapy (270, 18%). Common regimens were carboplatin + pemetrexed/paclitaxel (502, 80%) and bevacizumab + carboplatin + pemetrexed/paclitaxel (127, 20%) for CTX, pembrolizumab (167, 89%) for IT, and carboplatin + pemetrexed + pembrolizumab (153, 41%) for chemo-IT. Overall disease control rate was 58% with a median follow-up of 69.7 months. The 2- and 5-year OS were 30% and 12%, respectively. OS improved from 20% (2010–2012) to 38% (2019–2022) (P < 0.05). Modern regimens were associated with a 23% reduced hazard of death (HR 0.77, 95% CI 0.66–0.90, p < 0.001).

Conclusion

Modern regimens were associated with improved survival in stage IV NS-NSCLC, but long-term survival remains poor, underscoring the need for further research.