Long Term Survival in Patients with Metastatic Adenocarcinoma of the Lung in the Era of Targeted Agents

Author(s) :

Doru Paul1 and Marissa Rybstein2

1Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA

2Division of Hematology-Oncology, Department of Medicine, NYU Long Island School of Medicine, New York, USA

Corresponding author: Doru Paul, Email: dop9054@med.cornell.edu

Published: Volume I, Issue 2 (December 2021) 41-54, , , - DOI: 10.53011/JMRO.2021.02.05

Open Access

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December 27, 2021 0 Comments


Introduction: Several studies have shown that tyrosine kinase inhibitors (TKI) and chemotherapy improve the short term and median survival of patients with metastatic adenocarcinoma of the lung (MAL), but there is less data on the long-term survival (LTS) of these patients.

Methods: A univariate retrospective analysis was performed on 174 patients with MAL diagnosed at our institution between 2009 and 2011, and with up to a 5-year follow-up. Overall survival was estimated using the product-limit method and drawing the Kaplan-Meier curves and compared using the log-rank test.

Results: Factors associated with a statistically significant survival benefit in our patients were: having undergone lung surgery, female gender, never smokers, bronchioalveolar histology, and lower TNM nodal stage.  Particularly prior lung surgery was shown to improve survival in patients treated with erlotinib.  This was also true when comparing patients from a historical cohort as well.  Among patients with EGFR mutation, there was no statistically significant difference in survival amongst patients treated with either surgery or erlotinib.

Conclusion: In our patients with MAL the only treatment modality that improved LTS in a statistically significant way was lung surgery. This is an important finding as NCCN guidelines consider surgery as a treatment option only in MAL with isolated lesions.


Fig. 1: Summarizes the survival of patients on erlotinib therapy versus non-erlotinib therapy. At the 40-month time point, there were 4 patients observed to be alive in the erlotinib group versus 15 in the non-erlotinib group.
Fig 2: Summarizes the survival of patients with lung surgery versus non-lung surgery
Fig 3: Summarizes the benefit of surgery versus erlotinib in patients with EGFR mutations. Given the improvement in survival with surgery, this figure compares survival benefit of surgery in the non-erlotinib group vs the benefit of erlotinib in the group of patients with tumors harboring EGFR mutations.
Fig. 4: Kaplan Meier survival curves of lung surgery vs non-lung surgery at different time periods (2003-2008) and (2009-2011), respectively.
Fig. 5: Kaplan Meier survival curves of EGFR mutation status positive (13 patients) vs EGFR mutation status unknown (20 patients)
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