From the Guidelines
Approximately 55% of non-small cell lung cancer (NSCLC) patients present with metastatic disease at diagnosis. This high percentage reflects the often asymptomatic nature of early-stage lung cancer, which allows the disease to progress silently until it has spread beyond the lungs to distant sites such as the brain, bones, liver, or adrenal glands 1. Many patients only seek medical attention when they develop symptoms related to advanced disease, such as persistent cough, chest pain, shortness of breath, unexplained weight loss, or symptoms specific to the site of metastasis.
Key Points
- The high rate of metastatic disease at diagnosis contributes significantly to the poor overall prognosis associated with lung cancer 1.
- NSCLC represents more than 80% of lung cancer cases and includes two subtypes: non-squamous and squamous cell carcinoma 1.
- Early detection through screening with low-dose CT scans has been shown to reduce lung cancer mortality by identifying the disease when surgical resection or definitive local therapy is still possible.
Clinical Implications
- The importance of lung cancer screening programs for high-risk individuals, particularly long-term smokers, cannot be overstated, as it can detect the disease at earlier, more treatable stages before metastasis occurs 1.
- Clinicians should be aware of the high percentage of NSCLC patients presenting with metastatic disease and prioritize early detection and treatment to improve patient outcomes.
- Roughly 30% of NSCLC patients present with locally advanced disease, including mediastinal lymph node involvement, highlighting the need for prompt and effective treatment 1.
From the Research
Percentage of NSCLC Presenting with Metastatic Disease
- The percentage of non-small cell lung cancer (NSCLC) patients presenting with metastatic disease at diagnosis is approximately 30-40% 2.
- A real-world study found that among young NSCLC patients (age < 50 years), 67% presented with metastatic disease 3.
- Another study reported that most patients with NSCLC present with advanced stage disease, and the majority of those who present with earlier disease will ultimately develop and succumb to metastatic lung cancer 2.
Key Findings
- The addition of pembrolizumab to chemotherapy has been shown to significantly improve overall survival and progression-free survival in patients with metastatic NSCLC, regardless of PD-L1 expression 4, 5, 6.
- The optimal duration of chemotherapy in advanced NSCLC is typically 4 cycles, with no added benefit of extending treatment beyond this point 2.
- Targeted therapy options, such as EGFR mutation status, can improve survival in patients with metastatic NSCLC 3.