Changes in survival in de novo metastatic cancer in an era of new medicines

Abstract

Background Over the past decades, the therapeutic landscape has markedly changed for patients with metastatic solid cancer, yet few studies have evaluated its effect on population-based survival. The objective of this study was to evaluate the change in survival of patients with de novo metastatic solid cancers during the last 30 years. Methods For this retrospective study, data from almost 2 million patients diagnosed with a solid cancer between January 1, 1989, and December 31, 2018, were obtained from the Netherlands Cancer Registry, with follow-up until January 31, 2021. We classified patients as with or without de novo metastatic disease (M1 or M0, respectively) at diagnosis and determined the proportion with M1 disease over time. Changes in age-standardized net survival were calculated as the difference in the 1- and 5-year survival rates of patients diagnosed in 1989-1993 and 2014-2018. Results Different cancers showed divergent trends in the proportion of M1 disease and increases in net survival for M1 disease (approximately 0-50 percentage points at both 1 and 5 years). Patients with gastrointestinal stromal tumors saw the largest increases in 5-year survival, but we also observed substantial 5-year survival increases for patients with neuroendocrine tumors, melanoma, prostate cancer, and breast cancer. Conclusion Over 30 years, the survival of patients with de novo M1 disease modestly and unevenly increased among cancers. Metastatic cancer still remains a very lethal disease. Next to better treatment options, we call for better preventive measures and early detection to reduce the incidence of metastatic disease.

Survival in Patients With De Novo Metastatic Prostate Cancer

“…This cross-sectional study found that median OS in de novo mHSPC was similar in SEER and VHA and had improved significantly in the US population from 2000 to 2019, particularly in patients younger than 70 years. The improvements in OS mirror those observed in other countries and are likely due to the increased use of combination therapy . Our results suggest that new treatment paradigms may contribute to longer OS in clinical practice, which is the ideal setting to measure improvements in outcomes as treatments change.…”

Critical survival periods in prostate cancer in Sweden explored by conditional survival analysis

“…However, the reasons may be more complicated. In the Netherlands, metastatic data are available on all common cancers and the proportion of M1 of all PC varies extensively over time 29 . It was over 25% around 1990 and then decreased to 13% around 2010 and increased again towards 2018 to almost 20% 29 .…”

“…In the Netherlands, metastatic data are available on all common cancers and the proportion of M1 of all PC varies extensively over time 29 . It was over 25% around 1990 and then decreased to 13% around 2010 and increased again towards 2018 to almost 20% 29 . PSA testing for PC started in the Netherlands at around 1990 similar to Sweden 30 .…”

“…PSA testing for PC started in the Netherlands at around 1990 similar to Sweden 30 . In the Netherlands relative 1‐year survival of M1 patients increased from 79% in 1989–93 to 89% in 2014–18, and 5‐year relative survival increased from 23% to 42% 29 . Our data for M1 in 2009–13 were 83.8% for 1‐year (Figure S3) and 37.5% for 5‐year relative survival (Figure 3), thus somewhat below the Dutch survival figures although our data were from earlier years.…”

Illness trajectories of incurable solid cancers

“…Many patients with incurable solid cancer still die within months of being diagnosed, others may live for a considerable time 22. A retrospective study in the Netherlands that included almost two million patients with solid cancer showed a median survival of less than 7 months in patients with incurable solid cancer 38. Research investigating the actual increase of survival rates within cancer care has been limited to specific cancer types, and with specific genetic mutations or rearrangements (table 1).…”