The evolving survival landscape in advanced non-small cell lung cancer: an interrupted time series analysis

BACKGROUND: Treatment of advanced non-small cell lung cancer (NSCLC) has shifted from chemotherapy to targeted therapy and immunotherapy. We aimed to evaluate the effects of these novel therapies on advanced NSCLC in real-world setting. RESEARCH DESIGN AND METHODS: We conducted a retrospective cohort study using the SEER database of patients with advanced NSCLC receiving systemic therapy. Patients were stratified into three periods: chemotherapy (1992-2002), targeted therapy (2003-2014), and immunotherapy (2015-2022). We used interrupted time series analysis to evaluate changes in overall survival rate and cancer-specific survival rate (CSSR). RESULTS: The analysis included 32,899 patients. Compared to chemotherapy (11.9 months), median overall survival was significantly longer with targeted therapy (19.3 months) and immunotherapy (27.4 months). The 3-year CSSR increased by 0.36% and 0.89% per year following targeted therapy and immunotherapy, respectively. Adenocarcinoma showed sustained improvement in 3-year CSSR after targeted therapy (0.52% per year) and immunotherapy (0.83% per year), while squamous cell carcinoma showed no significant change. Most subgroups showed continuous survival improvement after immunotherapy. CONCLUSION: The introduction of targeted therapy and immunotherapy has produced significant survival improvement in adenocarcinoma, with the most pronounced benefits with immunotherapy. Treatment efficacy varies across subgroups highlighting the need for further investigation to optimize personalized therapy.