Therapeutic evolution: Adoption of newly approved systemic therapies in resected stage IB-IIIA NSCLC in the United States.

OBJECTIVES: Evidence is limited regarding use of immunotherapies and targeted therapies in early-stage and locally advanced non-small cell lung cancer (NSCLC) in clinical practice. This retrospective, observational cohort study used health records from US oncology practices to describe treatment patterns and evaluate outcomes in patients with resected stage IB-IIIA NSCLC. MATERIALS AND METHODS: Adult patients with stage IB-IIIA NSCLC who completed primary surgery from January 2019-December 2023 (n = 14,638) were included, with potential follow-up through August 2024. Subset analyses of stage II-IIIA NSCLC (n = 9,932) were also conducted. Neoadjuvant and adjuvant therapy use was described by stage, biomarker status, and year of surgery. Outcomes included disease-free survival (DFS) and overall survival (OS). RESULTS: Among 14,638 patients (median age, 70 years) 32.1 % were diagnosed with stage IB, 39.2 % with stage II, and 28.6 % with stage III disease. During the study period, 58.3 % received any systemic treatment (47.7 % platinum-based chemotherapy, 18.1 % immunotherapy, and 4.9% targeted therapy), primarily in the adjuvant setting. Immunotherapy and osimertinib use increased over time: by 2023, 48.6 % of patients with stage II-IIIA disease received immunotherapy, and 58.0 % of patients with stage IB-IIIA EGFR-mutant NSCLC received osimertinib. Median DFS was 46.2 months for overall study cohort and 38.4 months for patients with stage II-IIIA disease. The 3-year OS was 72.9 % for the overall study cohort. CONCLUSIONS: The treatment landscape for early-stage and locally advanced NSCLC has rapidly evolved with recent approvals. Real-world data from large clinical practice studies provide value in understanding use and outcomes of new treatments and identifying potential clinical practice gaps and unmet need.