Patterns of mortality in lung cancer patients in the era of immunotherapy and targeted therapy: A single-center, retrospective, observational study.

Abstract

e20627 Background: Over the past decade, immunotherapies and targeted therapies have revolutionized the treatment of lung cancer patients. While the outcomes have greatly improved, lung cancer still remains the leading cause of cancer deaths worldwide. Previous studies have shown cardiovascular and pulmonary problems to be the leading causes of death in these patients. However, the common causes of death in the era of immunotherapy and targeted therapy remain unclear. Methods: In this single-center retrospective observational study, we explored the patterns of mortality in patients with lung cancer in the current era. We chart reviewed all patients diagnosed with lung cancer between July 2020 and June 2023, stratified them according to the tumor histology and presence of metastasis, and collected details about their mortality. We performed survival analysis using Kaplan-Meier curves. Results: A total of 646 patients were diagnosed with primary lung cancer, with 329 (50.9%) patients having adenocarcinoma (ADC), 151 (23.4%) patients having squamous cell cancer (SCC), and 154 (23.8%) patients having small cell lung cancer (SCLC). 12 patients had mixed histology. 73.9%, 71.55%, and 80.5%, respectively, of the patients with ADC, SCC, and SCLC had metastatic lung cancer at diagnosis. The average age was 69 years, with 58.4% being males. At the last follow-up, 271 (42.7%) of the 634 patients had died. The median overall survival (OS) for all patients was 29.5 months, with 36.4 months, 45.9 months, and 12.4 months, respectively, in patients with ADC, SCC, and SCLC (p < 0.001). The median OS for patients with metastatic ADC, SCC, and SCLC were 19.8 months, 23.6 months, and 10.5 months, respectively (p < 0.001). When compared to patients with SCLC (4.5%), patients with ADC (20.1%) and SCC (34.4%) had a much higher chance of having concomitant second primary malignancy (p < 0.001). Most patients had more than one factor contributing to their death. Disease progression/metastasis contributed to 70.1%, 66.7%, and 77.9% of the deaths in patients with ADC, SCC, and SCLC, respectively. The cause of death was unknown in 20.7% of the patients, most of whom died at home. Among patients without progressive disease, infection (38.9%) was the leading cause of death. Cardiovascular causes (30%) were the second most common in the ADC group, whereas respiratory failure (35%) was more common in the SCC group. Other causes included neurological (5.2%), gastrointestinal (3.9%), and other miscellaneous causes (7.8%). Conclusions: While progressive disease still remains the most common cause of death in patients with lung cancer, infections, respiratory failure, and cardiovascular causes contribute to ~65% of deaths in patients without progressive disease. Understanding common factors contributing to mortality and addressing them is vital to improving outcomes in these patients.