Evolution of diagnostic and treatment strategies in advanced lung cancer over 2 decades at a large cancer center: a retrospective cohort study

Background: Advances in diagnostic technologies and the development of novel therapies have transformed standards for diagnosing and treating advanced lung cancer over the past two decades. This study evaluates how these changes have influenced diagnostic procedures and treatment strategies for advanced lung cancer patients at a tertiary care thoracic oncology center in Germany. Methods: We conducted a retrospective analysis of 2.037 patients with advanced lung cancer registered in our tumor database, diagnosed between 2010-2022. Patients were divided into three time cohorts, based on the timeline of EMA checkpoint-inhibitor approvals for NSCLC: Cohort 1 (2010-2014); Cohort 2 (2015-2017); Cohort 3 (2018-2022). We compared tumor histology, utilization of molecular testing, including next-generation sequencing, detection rates of driver mutations and treatment strategies across the three cohorts. Results: We observed a rising frequency of adenocarcinoma, a decline in small-cell lung cancer (AC/SCLC: C1=56,0%/16,2%; C2=63,1%/16,4%; C3=65,3%/10,9%; p=