REAL WORLD DATA ON LOCALLY ADVANCED NON-SMALL CELL LUNG CANCER (NSCLC) PATIENTS IN BRAZIL AND THE IMPACT OF HEALTH INSURANCE TYPE ON CLINICAL OUTCOMES (RELANCE STUDY / LACOG 0118)

Background: Lung cancer is a leading cause of cancer-related death worldwide. Stage III non-small cell lung cancer (NSCLC) represents 20-30% of cancer cases at diagnosis and most recently immunotherapy following chemoradiation improved overall survival in this setting. There is limited data on the current management and outcomes of locally advanced NSCLC in Brazil and whether health insurance coverage impact them. Objective The RELANCE study aims to retrospectively collect data regarding diagnosis, staging, treatment patterns and outcomes of patients diagnosed with locally advanced NSCLC in Brazil. Methods: Patients with histologically confirmed stage III NSCLC diagnosed between January 2015 and June 2019 were included. Clinicopathologic characteristics, staging work-up, treatment patterns, and outcomes were extracted from medical records. The primary objective was to describe overall survival (OS). Secondary outcomes included describing PFS, demographic and clinicopathological characteristics, and to compare patterns of care and outcomes between the private and public health care system. Results: We included 403 patients from 13 Brazilian centers. Median age was 66.0 (range, 27 – 90) years, 258 (64.0%) were male, and 272 (67.7%) were covered by the Brazilian public health system. Regarding histology, 205 (50.4%) had adenocarcinoma, 184 (45.2%) had squamous cell carcinoma and 18 (4.5%) had other histologies. Stage was IIIA in 193 (47.9%), IIIB in 186 (46.1%), and IIIC in 24 (6.0%) patients . After a median follow-up of 34.2 months, median PFS and OS were 11.2 (95% CI, 10.7 – 12.8) and 28.0 (95% CI, 21.6 – 31.7) months, respectively. The 24-month OS rate was 52.8%. After controlling for age, stage, and histology, being treated in the public health system was associated with a higher risk of progression (HR 1.33, 95% CI 1.03 – 1.71, P = 0.029) and death (HR 1.84, 95% CI 1.33 – 2.55, P < 0.001). Conclusion: Our study shows that Brazilian patients with stage III have similar outcomes in terms of PFS and OS than described in the literature before the incorporation of immunotherapy after chemoradiation. Despite that, patients covered by the public health system demonstrated worse PFS and OS.