1. DiGiulio, Sarah

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Population-level mortality from non-small cell lung cancer (NSCLC) fell sharply in the United States from 2013 to 2016, according to the findings of a new study that analyzed Surveillance, Epidemiology, and End Results (SEER) survey data. Improvements were found across patients of all races and ethnic groups that the study accounted for. The data were published online ahead of print in the New England Journal of Medicine (2020; doi: 10.1056/NEJMoa1916623).

Nadia Howlader, PhD.... - Click to enlarge in new windowNadia Howlader, PhD. Nadia Howlader, PhD

What's noteworthy is that deaths from NSCLC decreased at a higher rate than the decrease in incidence of other cancers. Among men, deaths from NSCLC decreased 3.2 percent annually from 2006 to 2013 and 6.3 percent annually from 2013 to 2016. Incidence of NSCLC in men decreased 1.9 percent annually from 2001 to 2008 and 3.1 percent annually from 2008 to 2016. Two-year survival rates for men with NSCLC increased from 26 percent to 35 percent from 2001 to 2014.


What else is noteworthy is that these trends line up with the arrival and use of new drugs that target genetic mutations (like epidermal growth factor receptor [EGFR] and anaplastic lymphoma kinase [ALK]).


In an interview with Oncology Times, the study's lead author Nadia Howlader, PhD, Mathematical Statistician in the NCI's Data Analytics Branch of the Division of Cancer Control and Population Sciences, shared why the data is significant.


1 According to the paper, you and your fellow researchers attribute the drop in mortality rate to advances in treatment, even though the data doesn't necessarily tell us which patients received which treatments. How do we know it's the new drugs that are making the difference?

"We had considered what other factors could potentially impact the death rates falling so sharply. Could there be screening, for example, that could really make a reduction in death rates? We had considered that possibility.


"But what we found instead is that the uptick in lung cancer screening rates in the United States has been low, and rates [overall] were really stable during this time period. So, screening rates definitely did not explain the declines we observed.


"Instead the decline in death rates really reflect the drop in, to some extent lung, cancer incidence rates by subtype, which can be attributed to smoking cessation. But in large part, due to treatment advancements."


2 The data shows that even though improvements were seen for people of all races and ethnicities, there were still racial disparities among the groups you looked at. Did each group see equal improvements? Do your results indicate there are disparities in who is receiving these more advanced treatments?

"The NCI SEER database includes data for four major race groups: non-Hispanic whites, and people who are Black, Asian, and Hispanic. What we found was that there was a continued increasing trend in survival rates.


"There were of course differences in the levels. If you look at our paper, you see people who are Black experience worse survival outcomes compared to other race and ethnic groups, but the trend continued upward. So clearly there has been improvement in therapy and it's been showing up in the survival trends over this time period."


3 What is the bottom-line takeaway message that practicing oncologists and cancer care providers should know about your work?

"This study highlights the impact new therapies have made down to the population level, which is very exciting. For oncologists, [these data] offer a sense of how these drugs have been applied and demonstrated to be effective for a very large population of NSCLC patients. Mortality is really going down at a population level.


"This really gives us hope that, for something as aggressive as lung cancer, there are opportunities for treatment.


"And since our study has come out, there are hundreds of new classes of drugs, particularly immunotherapies (like immune checkpoint inhibitors) that have been approved and disseminated. We will be monitoring closely and checking the trends because we suspect we might see even a bigger impact of newer immunotherapies on mortality trends sometime in the near future.


"And I also think it's very important for newly diagnosed cancer patients to have conversations with their oncologists to better understand their diagnosis and what type of lung cancer they've been diagnosed with. Because, depending on the type of lung cancer the patient has, the treatment and the prognosis could be really different. So, it's a really important conversation to have."