Improvement in Survival in Patients With Advanced Non-small Cell Lung Cancer

Background/Aim: New treatment agents for advanced non-small cell lung carcinoma (NSCLC) have improved overall survival (OS) in the last 20 years. Nevertheless, treatment strategies for patients with NSCLC and pulmonary fibrosis have not yet been established. This study aimed to evaluate OS improvement in patients with stage IV NSCLC based on the underlying pulmonary diseases. Patients and Methods: This study retrospectively reviewed 581 patients with stage IV NSCLC who received any antineoplastic agents. Patients were categorized into three groups based on their underlying pulmonary conditions: normal lungs, emphysema, and fibrosis. Additionally, patients were divided into four periods: A (2002-2006), B (20072011), C (2012-2016), and D (2017-2021). OS of patients with each underlying pulmonary disease was compared across the different periods and treatment agents [cytotoxic agents (CYs) only, molecular-targeted tyrosine kinase inhibitors (TKIs), and immune checkpoint inhibitors (ICIs)]. Results: Emphysema and fibrosis were identified in 205 (35.3%) and 54 (9.3%) patients, respectively. Over the last two decades, the OS (months) of all patients improved (p<0.001), including patients with normal lungs (p=0.004) and patients with emphysema (p<0.001), but with significant improvement in fibrosis (p=0.605). TKI and ICI improved OS in patients with normal lungs (p<0.001) and emphysema (p<0.001), but had no significant impact on OS in patients with fibrosis (p=0.502). Conclusion: Patients with advanced NSCLC have improved prognoses in the last years except for patients with pulmonary fibrosis. To improve the prognosis of patients with lung cancer and pulmonary fibrosis, new strategies and treatments should be developed.