Australians with advanced lung cancer are unlikely to survive longer than two years after they commence treatment, according to new research which has highlighted the limitations of chemotherapy as a front-line defence against the nation’s leading cancer killer.

Global research reveals that Australians with advanced non-small cell lung cancer survive just 19.6 months (median) after receiving two lines of treatment compared with Taiwan, where patients live more than twice as long (41.3 months). More Taiwanese patients than Australians have a molecular mutation within their lung cancers that make them suitable for newer, more effective and less toxic targeted treatment, rather than conventional chemotherapy.

Published in this month’s edition of the European Journal of Cancer Care, the study also found that 62 per cent of Australian patients with advanced non-small cell lung cancer proceeded with further treatment beyond first-line chemotherapy. The main reasons for not pursuing further lines of treatment were physical frailty and comorbidities. In comparison, 71 per cent of Taiwanese patients with advanced non-small cell lung cancer were able to receive subsequent therapy in part due to receiving less toxic and more effective targeted treatment upfront.

The PIvOTAL study (Global treatment Patterns, resource utilisation and bIOmarker Testing of Advanced non-small cell Lung cancer) analysed the medical outcomes of more than 1,200 patients with advanced non-small cell lung cancer from Australia, Korea, Taiwan, Italy, Spain, Germany and Brazil who received first-line therapy including chemotherapy between January 2011 and June 2014. The study was sponsored by Merck & Co, the parent company of MSD Australia.

Study co-author Dr Say Liang Ng, Medical Oncologist, said while the longer survival rates in Taiwan were due to more patients being treated with newer targeted therapies that target a molecular mutation within lung cancer which is more common in the Asian population, the analysis nevertheless demonstrated that chemotherapy is failing many patients.

“It’s time to rethink the chemotherapy-first approach. While chemotherapy may have a place for some patients, many lung cancer patients miss out on newer treatments because they are either too sick or die following initial therapy,” Dr Ng said.

Dr Ng said he was hopeful that new immunotherapies would be added to the Pharmaceutical Benefits Scheme as a first line of defence in the treatment of advanced lung cancer.

“These therapies activate the immune system to fight cancer cells and offer a completely different way of combating lung cancer. The more options we have, the better the chance of holding the cancer at bay,” Dr Ng said.

“More must be done for advanced lung cancer. Having the opportunity to access viable treatments which have fewer side-effects would be highly desirable, in addition to conventional chemotherapy,” Dr Ng added.

Lung Cancer in Australia

• More than 12,000 Australians will be diagnosed with lung cancer and almost 9,000 Australians will lose their lives to the disease this year alone;
• Lung cancer is Australia’s biggest cancer killer, causing almost 20 per cent of all cancer-related deaths, and more deaths than breast, prostate, and ovarian cancer combined;
• The outlook for patients with lung cancer is poor, with only a 15 per cent chance of surviving for five years after diagnosis. For patients diagnosed with advanced disease – where the cancer has spread from the lung to other parts of the body – the five year survival rate drops to just one per cent.3