Study Reports Longest Median Survival Rate for Stage 4 Lung Cancer

Advancements in cancer therapy have improved survival time for patients with non-small cell lung cancer (NSCLC), according to a new study published in the Journal of Thoracic Oncology.

From 1995 to 2001, patients with NSCLC, an aggressive form of lung cancer, had a 15% chance of being alive 5 years later, according to the National Cancer Institute. New data suggest that the percentage of patients alive 5 years after diagnosis has jumped significantly, likely due to the advancement of targeted treatments for the disease.

For the study, the researchers examined 110 patients diagnosed with stage 4 NSCLC whose tumors tested positive for rearrangements of the anaplastic lymphoma kinase (ALK) gene between 2009 and 2017. Of the patients in the study, 83% were never smokers and had a median age of 53 years. Most of the patients received crizotinib as their initial ALK inhibitor, according to the study. After treatment with crizotinib, 78% of patients who showed evidence of worsening disease were transitioned to another ALK inhibitor.

With a median follow-up of 47 months, the median overall survival (OS) from diagnosis of stage 4 disease was 6.8 years, indicating that 50% of patients were alive 6.8 years after diagnosis versus only 2% being alive after 5 years.

“Many studies have reported shorter overall survival for patients with stage IV ALK+ NSCLC treated with crizotinib,” study author Jose Pacheco, MD, investigator at CU Cancer Center, said in a press release. “These studies had lower survival outcomes in large part because of a lower percentage of patients receiving next-gen ALK inhibitors after progressing on crizotinib. Patients here were getting next-gen ALK inhibitors in phase 1 and 2 clinical trials before many other centers had access to them.”

Additionally, the researchers found that brain metastasis at diagnosis of stage 4 disease and year of stage 4 disease presentation did not influence OS, but more organs with tumor at diagnosis was associated with worse OS.

Dr Pacheco noted that the use of pemetrexed-based chemotherapies influenced survival, as the therapy works especially well against the ALK+ form of the disease.

“We try to use mainly pemetrexed-based chemotherapies in ALK+ lung cancer,” he said in the release. “It is possible shorter survival in other studies may be associated with use of non-pemetrexed based chemotherapies.”

“At this point, 6.8 years is one of the longest median survivals ever reported for a NSCLC subpopulation stage IV disease,” Pacheco concluded. “It shows the benefit of targeted therapy and how it’s changing survival for a lot of patients. And I think it suggests that for some types of NSCLC, it may become much more of a chronic condition rather than a terminal disease.”

References

• Pacheco JM, Gao D, Smith D, et al. Natural history and factors associated with overall survival in stage IV ALK rearranged non-small cell lung cancer. Journal of Thoracic Oncology. 2018. https://doi.org/10.1016/j.jtho.2018.12.014
• With the right care, patients now living a median 6.8 years after stage IV ALK+ lung cancer diagnosis [news release]. University of Colorado Cancer Center’s website. https://coloradocancerblogs.org/with-the-right-care-patients-now-living-a-median-6-8-years-after-stage-iv-alk-lung-cancer-diagnosis/. Accessed January 2, 2019.