TY - JOUR
T1 - An Observational Study on Treatment Outcomes in Patients With Stage III NSCLC in Taiwan
T2 - The KINDLE Study
AU - Su, Po Lan
AU - Chang, Gee Chen
AU - Hsiao, Shih Hsin
AU - Hsia, Te Chun
AU - Lin, Meng Chih
AU - Lin, Min Hsi
AU - Shih, Jin Yuan
AU - Yang, Cheng Ta
AU - Yang, Sheng Hsiung
AU - Chen, Yuh Min
N1 - Funding Information:
Disclosure: Dr. Shih reports receiving personal fees as a member of an advisory board from AstraZeneca, Eli Lilly, Novartis, Pfizer, Bristol-Myers Squibb, Merck, Roche, and Amgen; speaking honoraria from AstraZeneca, Eli Lilly, Novartis, Pfizer, Bristol-Myers Squibb, Merck, Roche, Chugai, and Boehringer Ingelheim; and a research grant from Roche. Dr. Chang reports receiving speaking honoraria from AstraZeneca, Eli Lilly, Novartis, Pfizer, Bristol-Myers Squibb, Merck, Roche, and Boehringer Ingelheim. Dr. Lin reports receiving personal fees as a member of an advisory board from Roche, AstraZeneca, and Boehringer Ingelheim. Dr. Hsia reports receiving speaking honoraria and research grants from AstraZeneca, Boehringer Ingelheim, Roche, Pfizer, and Merck. The remaining authors declare no conflict of interest.
Funding Information:
The authors declare that this study received funding from AstraZeneca, Taiwan. The authors received medical writing and editorial support for the manuscript preparation from Formosa Biomedical Technology Co. Ltd. which was funded by AstraZeneca. The authors thank all the patients and their families for their support.
Funding Information:
The authors declare that this study received funding from AstraZeneca, Taiwan. The authors received medical writing and editorial support for the manuscript preparation from Formosa Biomedical Technology Co., Ltd., which was funded by AstraZeneca. The authors thank all the patients and their families for their support.
Publisher Copyright:
© 2022 The Authors
PY - 2022/3
Y1 - 2022/3
N2 - Introduction: Patients with stage III NSCLC represent a very heterogenous group that requires different treatment strategies, especially in patients with N2 (2 nearby lymph nodes having cancer)-positive NSCLC and unresectable EGFR-mutant NSCLC. This real-world study may provide more insights into treatment decisions. Methods: The KINDLE study is a large, multinational real-world observational study that assessed different treatment strategies in patients with stage III NSCLC. Progression-free survival (PFS) and overall survival (OS) were estimated and compared using Kaplan-Meier and log-rank testing. Patients were classified on the basis of disease stage, resectability, and treatment modalities. Results: The Taiwan subgroup enrolled 200 patients. The median PFS and OS values were similar among patients with stage IIIA and stage IIIB disease, but were significantly better in patients who were deemed as a resectable disease than in those who were deemed as an unresectable disease. In patients with N2-positive NSCLC, patients who underwent surgery had better PFS, but not OS, than patients administered with chemoradiotherapy (CRT) (PFS 13.4 vs. 7.3 mo, hazard ratio [HR] = 0.18, p < 0.001; OS 32.4 vs. 22.0 mo, HR = 0.64, p = 0.215). Among patients with unresectable EGFR-mutant NSCLC, OS was significantly poorer after upfront EGFR–tyrosine kinase inhibitors (TKI) than after upfront CRT with sequential EGFR-TKI (27.4 vs. 49.0 mo, HR = 3.09, p = 0.03). Conclusions: Our study suggests that surgery could be added as part of therapy for patients with stage III N2-positive NSCLC. Moreover, upfront CRT with sequential EGFR-TKI seems to be appropriate for stage III unresectable EGFR-mutant NSCLC. Further randomized studies are needed to validate these results.
AB - Introduction: Patients with stage III NSCLC represent a very heterogenous group that requires different treatment strategies, especially in patients with N2 (2 nearby lymph nodes having cancer)-positive NSCLC and unresectable EGFR-mutant NSCLC. This real-world study may provide more insights into treatment decisions. Methods: The KINDLE study is a large, multinational real-world observational study that assessed different treatment strategies in patients with stage III NSCLC. Progression-free survival (PFS) and overall survival (OS) were estimated and compared using Kaplan-Meier and log-rank testing. Patients were classified on the basis of disease stage, resectability, and treatment modalities. Results: The Taiwan subgroup enrolled 200 patients. The median PFS and OS values were similar among patients with stage IIIA and stage IIIB disease, but were significantly better in patients who were deemed as a resectable disease than in those who were deemed as an unresectable disease. In patients with N2-positive NSCLC, patients who underwent surgery had better PFS, but not OS, than patients administered with chemoradiotherapy (CRT) (PFS 13.4 vs. 7.3 mo, hazard ratio [HR] = 0.18, p < 0.001; OS 32.4 vs. 22.0 mo, HR = 0.64, p = 0.215). Among patients with unresectable EGFR-mutant NSCLC, OS was significantly poorer after upfront EGFR–tyrosine kinase inhibitors (TKI) than after upfront CRT with sequential EGFR-TKI (27.4 vs. 49.0 mo, HR = 3.09, p = 0.03). Conclusions: Our study suggests that surgery could be added as part of therapy for patients with stage III N2-positive NSCLC. Moreover, upfront CRT with sequential EGFR-TKI seems to be appropriate for stage III unresectable EGFR-mutant NSCLC. Further randomized studies are needed to validate these results.
KW - Chemoradiotherapy
KW - Epidermal growth factor receptor mutation
KW - N2-positive disease
KW - Stage III non-small cell lung cancer
KW - Tyrosine kinase inhibitors
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U2 - 10.1016/j.jtocrr.2022.100292
DO - 10.1016/j.jtocrr.2022.100292
M3 - Article
AN - SCOPUS:85125141815
SN - 2666-3643
VL - 3
JO - JTO Clinical and Research Reports
JF - JTO Clinical and Research Reports
IS - 3
M1 - 100292
ER -
