Room for improvement in lung cancer treatment

A large multinational study reveals the diversity in treatment practices and outcomes in stage III non-small-cell lung cancer patients in low- and middle-income countries.


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Countries in the Middle East and Africa need to provide better therapies and care for lung cancer patients, according to a new study from KAIMRC.

Lung cancer remains one of the deadliest forms; about half of people diagnosed with lung cancer die within one year. Non-small cell lung cancer (NSCLC) accounts for almost 85% of lung cancer cases, and up to 30% of these patients are diagnosed with locally advanced (stage III) NSCLC. These patients are treated with a range of therapies, including surgery, radiation, chemotherapy, and, more recently, immunotherapy and targeted therapies.

Abdul Rahman Jazieh, a former KAIMRC researcher who is now at Cincinnati Cancer Advisors in the USA, led  the KINDLE study of more than 3,000 stage III NSCLC patients from 19 countries across Asia, the Middle East, Africa, and Latin America. “Until now, there were no or very limited data available on the treatment regimens and outcomes of these patients in low- and middle-income countries,” he says. 

The study included patients who were diagnosed between January 2013 and December 2017 with at least 9 months of follow-up, before the approval of the immunotherapeutic agent durvalumab, which has significantly reduced the risk of death of patients with stage III NSCLC. The authors examined the type of treatment the patients received, the duration of each treatment regimen, and the reasons for changing or ending treatment. 

They found more than 25 treatment approaches, suggesting that only a limited number of cases followed international guidelines. “It was surprising to find that the adherence to treatment guidelines varies and is low, which very likely leads to different outcomes in patients,” says Jazieh. 

The relapse rates in patients with resected and unresectable disease were high: 62% and 79%, respectively. The treatments associated with longer survival were surgery, concurrent chemoradiation, and triple therapy (surgery and chemoradiation), yet only a minority of patients (<40%) with unresectable disease received concurrent chemoradiation as an initial therapy.

The survival rates of stage III NSCLC patients in the Middle-East and Africa were worse than in the global cohort, highlighting the need for new therapies and quality care in this area. “There is a definite gap in optimal selection and sequencing of various treatment approaches,” Jazieh says. 

Jazieh and his colleagues in Saudi Arabia have published updated guidelines for the management of stage III NSCLC and are working to improve physician education and patient access to new medicines. Over the coming months, they will carry out in-depth regional and country-level specific analyses to improve the provision of lung cancer care. 

“The study provides a benchmark for understanding the existing treatment landscape and will serve as a basis for comparison of newer therapies in this population,” says Jazieh.


  1.  Jazieh, A.R. et al. Real-World Treatment Patterns and Clinical Outcomes in Patients With Stage III NSCLC: Results of KINDLE, a Multicountry Observational Study. J Thorac Oncol. Epub ahead of print 26 May 2021.  | article

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