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Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country
OBJECTIVE: To describe the survival outcomes of metastatic non-small cell lung cancer patients with limited access to immunotherapy and targeted therapy in a cancer reference center in Colombia. METHODS: A retrospective analysis of metastatic non-small cell lung cancer patients treated between 2013...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10403982/ https://www.ncbi.nlm.nih.gov/pubmed/37537995 http://dx.doi.org/10.1177/10732748231189785 |
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author | Ballén, Diego-Felipe Carvajal-Fierro, Carlos Andrés Beltrán, Rafael Alarcón, Martha-Liliana Vallejo-Yepes, Camilo Brugés-Maya, Ricardo |
author_facet | Ballén, Diego-Felipe Carvajal-Fierro, Carlos Andrés Beltrán, Rafael Alarcón, Martha-Liliana Vallejo-Yepes, Camilo Brugés-Maya, Ricardo |
author_sort | Ballén, Diego-Felipe |
collection | PubMed |
description | OBJECTIVE: To describe the survival outcomes of metastatic non-small cell lung cancer patients with limited access to immunotherapy and targeted therapy in a cancer reference center in Colombia. METHODS: A retrospective analysis of metastatic non-small cell lung cancer patients treated between 2013 and 2018 was performed, majority diagnosed with adenocarcinoma. It was carried out in a public cancer reference center that provides care to patients of low and middle socioeconomic status. Overall survival and progression-free survival were evaluated by Kaplan–Meier analysis and log-rank test. A Cox regression model was performed for univariate and multivariate analysis. RESULTS: 209 patients were included with majority of adenocarcinoma (79.5%). First-line treatment was cytotoxic chemotherapy (50.2%), EGFR-targeted therapy (14.8%), chemoimmunotherapy (1.9%), and ALK-targeted therapy (1.4%). 31.6% received best supportive care. Median time of follow-up was 13 months, median overall survival was 11.2 months (95% CI, 7.9–14.4), 13 months for adenocarcinoma (95% CI, 8.1–17.9), and 2.5 months for squamous cell carcinoma (95% CI, 0.6–4.4) (P < .001). Median progression-free survival was 9.3 months (95% CI, 7.9–10.7) without differences according to the type of first-line therapy. Median time-to-treatment was 55 days and only 54% of patients with a tested actionable mutation in EGFR received an EGFR-targeted therapy as the first-line treatment. Multivariate analysis showed that squamous cell carcinoma histology and receiving best supportive care were independent factors for worse overall survival ((HR:1.8, 95% CI, 1.076–3.082, P=.026) and (HR:14.6, 95% CI, 8.921–24.049, P < .001), respectively). Meanwhile, squamous cell carcinoma histology was an independent factor for worse progression-free survival (HR:3.4, 95% CI, 1.540-7.464, P=.002). CONCLUSIONS: Despite advances in precision medicine, during the study period, cytotoxic chemotherapy was the most used treatment in our patients. Furthermore, about a third of them received best supportive care. The use of targeted therapies has been restricted by access to molecular diagnosis and remained low until 2018. Access to immunotherapy should be prioritized. |
format | Online Article Text |
id | pubmed-10403982 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-104039822023-08-06 Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country Ballén, Diego-Felipe Carvajal-Fierro, Carlos Andrés Beltrán, Rafael Alarcón, Martha-Liliana Vallejo-Yepes, Camilo Brugés-Maya, Ricardo Cancer Control Original Research Article OBJECTIVE: To describe the survival outcomes of metastatic non-small cell lung cancer patients with limited access to immunotherapy and targeted therapy in a cancer reference center in Colombia. METHODS: A retrospective analysis of metastatic non-small cell lung cancer patients treated between 2013 and 2018 was performed, majority diagnosed with adenocarcinoma. It was carried out in a public cancer reference center that provides care to patients of low and middle socioeconomic status. Overall survival and progression-free survival were evaluated by Kaplan–Meier analysis and log-rank test. A Cox regression model was performed for univariate and multivariate analysis. RESULTS: 209 patients were included with majority of adenocarcinoma (79.5%). First-line treatment was cytotoxic chemotherapy (50.2%), EGFR-targeted therapy (14.8%), chemoimmunotherapy (1.9%), and ALK-targeted therapy (1.4%). 31.6% received best supportive care. Median time of follow-up was 13 months, median overall survival was 11.2 months (95% CI, 7.9–14.4), 13 months for adenocarcinoma (95% CI, 8.1–17.9), and 2.5 months for squamous cell carcinoma (95% CI, 0.6–4.4) (P < .001). Median progression-free survival was 9.3 months (95% CI, 7.9–10.7) without differences according to the type of first-line therapy. Median time-to-treatment was 55 days and only 54% of patients with a tested actionable mutation in EGFR received an EGFR-targeted therapy as the first-line treatment. Multivariate analysis showed that squamous cell carcinoma histology and receiving best supportive care were independent factors for worse overall survival ((HR:1.8, 95% CI, 1.076–3.082, P=.026) and (HR:14.6, 95% CI, 8.921–24.049, P < .001), respectively). Meanwhile, squamous cell carcinoma histology was an independent factor for worse progression-free survival (HR:3.4, 95% CI, 1.540-7.464, P=.002). CONCLUSIONS: Despite advances in precision medicine, during the study period, cytotoxic chemotherapy was the most used treatment in our patients. Furthermore, about a third of them received best supportive care. The use of targeted therapies has been restricted by access to molecular diagnosis and remained low until 2018. Access to immunotherapy should be prioritized. SAGE Publications 2023-08-03 /pmc/articles/PMC10403982/ /pubmed/37537995 http://dx.doi.org/10.1177/10732748231189785 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Article Ballén, Diego-Felipe Carvajal-Fierro, Carlos Andrés Beltrán, Rafael Alarcón, Martha-Liliana Vallejo-Yepes, Camilo Brugés-Maya, Ricardo Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country |
title | Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country |
title_full | Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country |
title_fullStr | Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country |
title_full_unstemmed | Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country |
title_short | Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country |
title_sort | survival outcomes of metastatic non-small cell lung cancer patients with limited access to immunotherapy and targeted therapy in a cancer center of a low- and middle-income country |
topic | Original Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10403982/ https://www.ncbi.nlm.nih.gov/pubmed/37537995 http://dx.doi.org/10.1177/10732748231189785 |
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