title: Impact of new chemotherapeutic and targeted agents on survival in stage IV non-small cell lung cancer.
abstract: OBJECTIVE
  Significant advances in the systemic management of metastatic non-small cell lung cancer (NSCLC) have occurred over the past decade, with options now including multiple lines of chemotherapy, epidermal growth factor receptor inhibitors, and antiangiogenic agents. Improvements in overall survival have been demonstrated in randomized controlled trials comparing these newer agents with best supportive care or standard therapy. This study examined uptake of these therapies in general practice and their impact on survival.
  
  
  METHODS
  This retrospective cohort study compared demographic, treatment, and survival data among 987 patients diagnosed with stage IV NSCLC at two institutions in 1998, 2003, and 2008. Cohorts were selected based on intervals when doublet chemotherapy, second-line chemotherapy, and targeted agents were incorporated into the standard treatment regimen.
  
  
  RESULTS
  The proportion of patients receiving systemic therapy increased over time (20% in 1998, 42% in 2008). Overall survival improved significantly across cohorts (p < .001), with 2-year survival rates of 0.3% in 1998, 4% in 2003, and 15% in 2008. In a multivariate survival analysis, the 2003 and 2008 cohorts were independently associated with longer survival, as was the use of one or more lines of systemic therapy. Elderly patients (aged ≥70 years) were also more likely to receive systemic therapy over time, with longer overall survival (p < .001).
  
  
  CONCLUSIONS
  Over the past decade, there has been an increasing use of systemic therapy in stage IV NSCLC patients, including the elderly. This has been associated with significantly longer overall survival.
authors.affiliation: Sunnybrook Odette Cancer Centre, T Wing 2nd Floor, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5.
authors.forename: Joanne L
authors.initials: JL
authors.lastname: Yu
authors.forename: Christine
authors.initials: C
authors.lastname: Simmons
authors.forename: J Charles
authors.initials: JC
authors.lastname: Victor
authors.forename: Dolly
authors.initials: D
authors.lastname: Han
authors.forename: Sophie
authors.initials: S
authors.lastname: Hogeveen
authors.forename: Natasha
authors.initials: N
authors.lastname: Leighl
authors.forename: Sunil
authors.initials: S
authors.lastname: Verma
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D058990:Molecular Targeted Therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents