Delay of systemic therapy confers a survival benefit in patients with stage IV non-small cell lung cancer

Introduction: A timely systemic therapy of patients with metastasized non small cell lung cancer (NSCLC) is a suggestive clinical conception. As the pre-therapeutic management is complex and includes comprehensive immunohistochemical and molecular diagnostics the time to optimal therapy may be prolonged. Whether timing of therapy influences outcome still remains controversial. We investigated therapy timing and overall survival in subgroups of NSCLC patients in the clinical cancer registry of Lower Saxony. Materials and Methods Patients with UICC stage IV NSCLC and systemic therapy were included. An early and delayed therapy group based on the median time from histology to therapy was defined. Median overall survival (mOS) was estimated by Kaplan-Meier and compared by log rank test. Uni- and multivariate cox regression analysis were used for independent variables. Subgroup analyses were performed according to age, ECOG-PS, metastasis stage (M1a-c) and therapy. Results 1687 patients were included, median age was 66.8 years, 58% of patients were male. The median time to systemic therapy was 33 days. 844 patients were in the early and 843 in the delayed therapy group (TG). Median overall survival (mOS) of the early TG patients was 9 m vs. 14 m in the delayed TG ( p < 0.001 ). Subgroup analyses confirmed consistent findings among different age, metastasis, and ECOG subgroups. Conclusion UICC IV NSCLC patients with a delayed systemic therapy had a better overall survival to than those with an early therapy. This observation supports a (qualified) waiting time for systemic therapies. Therapy timing may also be a relevant confounder in clinical studies.