Lung adenocarcinoma: 3-year survival has doubled since 2000

Median overall survival followed the same dynamic: it more than doubled in two decades (8.5 months in 2000; 20.7 months in 2020). This means that 50% of patients were still alive 20.7 months after the start of follow-up in 2020.
One observation: the proportion of adenocarcinomas has increased significantly, representing 56.1% of lung cancers in 2020 compared to less than a third in 2000. There are several types of lung cancer. Non-small cell lung cancers (more than 80% of cases) include adenocarcinomas (60%), squamous cell carcinomas (30%) and, more rarely, large cell carcinomas. Much rarer, "small cell" lung cancers represent around 15% of cases.
The importance of sex and cancer stage in diagnosis
The gap that was observed between women and men in 2000 still exists in 2020: 45.1% of women with adenocarcinoma were alive at 3 years, compared to 34.2% of men. On the other hand, the proportion of women among those diagnosed with adenocarcinoma has completely transformed: it has increased from 24.5% to 40.4%. The proportion of patients over 80 years of age has also doubled.
Furthermore, the stage of the cancer at the precise time of diagnosis is important and conditions survival, ranging in 2020 from 21.3% in patients with metastatic disease at the time of diagnosis to 84% in those with stage I disease (a localized form of cancer, which can be easily operated on).
Progress through targeted therapies
Several advances have contributed to improving care: increasing quality of imaging examinations, development of minimally invasive and robotic surgery, strengthening of perioperative strategies and more precise histological classification thanks to immunostaining. This technique makes it possible to detect, in tumor tissue, the presence of specific proteins (using antibodies). This is to specify the type of cancer (histology) by identifying characteristic markers. Specifically, in lung cancer, it helps to differentiate the subtypes of non-small cell lung cancers (adenocarcinoma, squamous cell carcinoma, etc.) and guides the choice of treatment.
Additionally, the introduction of molecular biology platforms has made it possible to identify targetable mutations specific to each tumor (EGFR, ALK, ROS1). In 2020, patients with these alterations treated with targeted therapies had a three-year overall survival rate of 36%, compared to 18.5% in the absence of the mutation. Among patients with metastatic disease without the molecular alterations mentioned above, the three-year overall survival rate was 36.2% with first-line immunotherapy versus 14.3% without immunotherapy, and the median overall survival was 21.0 months versus 4.2 months.
Immunotherapy prolongs survival in people with metastases
In patients without molecular alterations that can be targeted by immunotherapies, first-line drugs increased the 3-year overall survival rate to 36.2%, compared to 14.3% without immunotherapy. Median survival increased from 4.2 to 21 months.
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