In the treatment of metastatic non‑small cell lung cancer (NSCLC),

What's
keeping
survival out
of balance?

Despite therapeutic advances,
oncologists continue to face the
imbalance between additional toxicities from systemic treatments and extended survival in patients with metastatic NSCLC.^1,2,*

Stay in touch to learn more about what needs to change.

As metastatic NSCLC progresses, there remains a gap in the ability to extend survival without adding systemic treatment toxicities

The efficacy of chemotherapy following the first-line combination of immunotherapy and chemotherapy is modest and involves additional systemic toxicities that patients struggle to endure.^1,3

Consequences for patients

Treatment options for metastatic NSCLC are currently limited to biochemical systemic modalities that may result in limited median overall survival, especially in later lines of treatment.^3,4

Treatment choice may be complicated by:

The burden of toxicities from current systemic therapies^6,7

Patient's age and fitness for the continuation of treatment^8,9

Approximately half of patients treated for metastatic NSCLC experience a decline in physical functioning, which interferes with daily activities and overall well-being.^10,§

Moreover, studies in NSCLC that measure impact of chemotherapy regimens on tolerability and quality of life typically do not include toxicity-related patient discontinuation rates, which may exceed 30% among patients who receive combination therapies.^12,13

We need to consider

novel modalities that target tumor behaviors in innovative ways in order to extend survival without added systemic toxicities

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NSCLC, non-small cell lung cancer.

OS, overall survival.

Based on a multicenter retrospective study evaluating the efficacy of second-line chemotherapies after progression following first-line chemo‑immunotherapy in 124 patients with metastatic NSCLC (mean age 63).³

Chemotherapy and immunotherapy combinations in adults with NSCLC (≥65 years of age).¹⁰

ECOG, Eastern Cooperative Oncology Group.

References: 1. Ramirez RA, Lu J, Thomas KEH. Quality of life for non-small cell lung cancer patients in the age of immunotherapy. Transl Lung Cancer Res. 2018;7(Suppl 2):S149-S152. doi:10.21037/tlcr.2018.03.10 2. Suresh K, Naidoo J, Lin CT, Danoff S. Immune checkpoint immunotherapy for non-small cell lung cancer: benefits and pulmonary toxicities. Chest. 2018;154(6):1416-1423. doi:10.1016/j.chest.2018.08.1048 3. Auclin E, Benitez-Montanez J, Tagliamento M, et al. Second-line treatment outcomes after progression from first-line chemotherapy plus immunotherapy in patients with advanced non-small cell lung cancer. Lung Cancer. 2023;178:116-122. doi:10.1016/j.lungcan.2023.02.002 4. Garon EB, Ciuleanu T-E, Arrieta O, et al. Ramucirumab plus docetaxel versus placebo plus docetaxel for second-line treatment of stage IV non-small-cell lung cancer after disease progression on platinum-based therapy (REVEL): a multicentre, double-blind, randomised phase 3 trial. Lancet. 2014;384(9944):665-673. doi:10.1016/S0140-6736(14)60845-X 5. American Society of Clinical Oncology (ASCO). Lung cancer – Non-small cell: statistics. Cancer.Net. Accessed September 12, 2023. https://www.cancer.net/cancer-types/lung-cancer-non-small-cell/statistics#:~:text=For 6. Sjøgren K, Jacobsen KA, Grønberg BH, Halvorsen TO. Timing of severe toxicity from chemotherapy in patients with lung cancer. Anticancer Res. 2020;40(11):6399-6406. doi:10.21873/anticanres.14661 7. Yang F, Shay C, Abousaud M, et al. Patterns of toxicity burden for FDA‑approved immune checkpoint inhibitors in the United States. J Exp Clin Cancer Res. 2023;42(4):1-21. doi:10.1186/s13046-022-02568‑y 8. Kim J, Hurria A. Determining chemotherapy tolerance in older patients with cancer. J Natl Compr Canc Netw. 2013;11(12):1494-1502. doi:10.6004/jnccn.2013.0176 9. West H, Jin JO. Performance status in patients with cancer. JAMA Oncol. 2015;1(7):998. doi:10.1001/jamaoncol.2015.3113 10. Singhal S, Walter LC, Smith AK, et al. Change in four measures of physical function among older adults during lung cancer treatment: a mixed methods cohort study. J Geriatr Oncol. 2023;14(2):101366. doi:10.1016/j.jgo.2022.08.015 11. Sehgal K, Gill RR, Widick P, et al. Association of performance status with survival in patients with advanced non-small cell lung cancer treated with pembrolizumab monotherapy. JAMA Netw Open. 2021;4(2):e2037120. doi:10.1001/jamanetworkopen.2020.37120 12. Alexa T, Lavinia A, Luca A, Miron L, Alexa ID. Incidence of chemotherapy discontinuation and characteristics of elderly patients with non-small cell lung cancer treated with platinum-based doublets. Contemp Oncol (Pozn). 2014;18(5):340-3. doi:10.5114/wo.2014.45293 13. Gridelli C, Gallo C, Shepherd FA, et al. Gemcitabine plus vinorelbine compared with cisplatin plus vinorelbine or cisplatin plus gemcitabine for advanced non–small-cell lung cancer: a phase III trial of the Italian GEMVIN Investigators and the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2003;21(16):3025-3034. doi:10.1200/JCO.2003.06.099

What's keeping survival out of balance?

As metastatic NSCLC progresses, there remains a gap in the ability to extend survival without adding systemic treatment toxicities

Consequences for patients

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What's
keeping
survival out
of balance?