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How real-world data is enhancing our understanding of lung cancer recurrence

Non-small cell lung cancer (NSCLC) is among the most common and deadly cancers in the United States, with close to 200,000 new diagnoses each year and an overall five-year relative survival rate of just 28 percent.

While the incidence of lung cancer is decreasing over time, and survival rates are on the rise year-over-year, there is still much to learn about how to best treat this disease – and prevent its recurrence after initial therapy.

How real-world data is enhancing our understanding of lung cancer recurrence Blog

Real-world data (RWD) and real-world evidence (RWE) are instrumental in our efforts to better understand and treat NSCLC. By using rich, multimodal data such as clinical, claims, laboratory, pharmacy, and even patient-reported outcomes, to examine how NSCLC behaves in real-world patients, researchers can better understand the utilization pattern, tolerability and efficacy of approved treatments.

A team from COTA and Astra-Zeneca Pharmaceuticals has done exactly that, using curated RWD from COTA’s extensive database to examine factors that influence disease-free survival and recurrence patterns for NSCLC patients who initially presented with early stage disease.

“Surgical resection remains standard of care for patients with early-stage NSCLC, but research shows that adjuvant therapy can reduce the risk of disease recurrence,” the team explained in a manuscript published in the July 2023 edition of Cancer Treatment and Research Communications.

“Nonetheless, recurrence rates after early-stage NSCLC diagnosis remain high, between 30 percent and 77 percent, with the majority of recurrences being distant in nature and occurring within the first 2 years after resection,” the team continued. “Given the evolving therapeutic landscape in early-stage NSCLC, we sought to examine patterns of care, disease free-survival, and associated patient characteristics in the real-world setting by using a contemporary, US-based real-world database.”

The researchers gathered RWD for more than 700 patients diagnosed with early stage (IB-IIIA) NSCLC between 2013 and 2018 to explore the relationships between different therapeutic modalities and the length of disease-free survival (DFS) as determined by EHR documentation, including results of imaging scans, pathology reports, lab reports, and/or physician notation of recurrence.

Of the 703 patients included in the study, a total of 337 patients (47.9%) experienced a recurrence event or death during the observation period, with distinctly shorter DFS times in patients with more advanced stage disease, patients with a related genetic mutation (EGFRm positive), and those who did not receive therapy other than surgical resection.

Distant/metastatic recurrence was the most common event to trigger the end of the disease-free survival period among all patients. These findings further underscore the importance of the overall survival analysis from the pivotal ADAURA trial presented at the 2023 Annual Meeting of the American Society of Clinical Oncology.

The study confirmed previous industry findings that the disease stage at diagnosis is tied to shorter DFS and reinforced the hypothesis that adjuvant therapies can extend the disease-free survival time compared to surgical resection alone.

“Our study presents important research that fills a gap in the existing evidence base. Much of the literature describing recurrence rates in NSCLC is dated, and the more recent literature presents findings on populations outside of the United States,” the researchers concluded.

“To increase adoption of and better understand the effect of new approved adjuvant targeted therapies on DFS, additional research is needed. Ultimately, despite recent advances in adjuvant therapy, recurrence and death rates remain high among patients with early-stage NSCLC, and continued research is needed to further reduce the risk of disease recurrence in early-stage NSCLC.”