{
  "abstract": "Background: Advances in immunotherapy (IT) and targeted therapy have transformed treatment for stage IV non-squamous non-small cell lung cancer (NS-NSCLC). However, real-world data comparing modern regimens to previous standards remains limited. Herein, we aim to determine whether survival outcomes have improved with contemporary therapies,\n\nMethods: We conducted a retrospective analysis of de novo stage IV NS-NSCLC at diagnosis treated at the Cleveland Clinic, OH, from 1/2010 to 12/2022. Baseline variables, including age, sex, race, performance status, smoking history, PD-L1 testing, and molecular profiling, were collected along with treatment regimens. Treatment responses were assessed. Overall survival (OS) and progression-free survival (PFS) were estimated. Multivariable Cox regression (CPH) was used to adjust for confounding.\n\nResults: We identified 1,518 patients with NS-NSCLC, of which 97% had adenocarcinoma (N = 1,472). Median age was 65 (IQR 58–73); 51% were female, 82% white, and 42% current smokers. Treatments included conventional chemotherapy (CTX) (744, 49%), IT (186, 12%), CTX + IT (318, 21%), and targeted therapy (270, 18%). Common regimens were carboplatin + pemetrexed/paclitaxel (502, 80%) and bevacizumab + carboplatin + pemetrexed/paclitaxel (127, 20%) for CTX, pembrolizumab (167, 89%) for IT, and carboplatin + pemetrexed + pembrolizumab (153, 41%) for chemo-IT. Overall disease control rate was 58% with a median follow-up of 69.7 months. The 2- and 5-year OS were 30% and 12%, respectively. OS improved from 20% (2010–2012) to 38% (2019–2022) (P < 0.05). Modern regimens were associated with a 23% reduced hazard of death (HR 0.77, 95% CI 0.66–0.90, p < 0.001).\n\nConclusion: Modern regimens were associated with improved survival in stage IV NS-NSCLC, but long-term survival remains poor, underscoring the need for further research.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12885-026-16590-2.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine, Cleveland Clinic, Cleveland, OH USA",
    "Department of Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH USA",
    "Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH USA",
    "Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, CA Building, 10201 Carnegie Ave, Cleveland, OH 44106 USA",
    "Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic, Cleveland, OH USA"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 22,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Naveen Rehman"
    },
    {
      "affs": [
        1
      ],
      "name": "Emily C. Zabor"
    },
    {
      "affs": [
        0
      ],
      "name": "Aastha Dhakal"
    },
    {
      "affs": [
        0
      ],
      "name": "Bridget Adcock"
    },
    {
      "affs": [
        0
      ],
      "name": "Muaz Alsabbagh Alchirazi"
    },
    {
      "affs": [
        0
      ],
      "name": "Moath Albliwi"
    },
    {
      "affs": [
        0
      ],
      "name": "Ali Mushtaq"
    },
    {
      "affs": [
        0
      ],
      "name": "Hadil Zureigat"
    },
    {
      "affs": [
        0
      ],
      "name": "Monica Lee"
    },
    {
      "affs": [
        0
      ],
      "name": "Ahmed Nabil Mohamed Hassan"
    },
    {
      "affs": [
        0
      ],
      "name": "Heya Batah"
    },
    {
      "affs": [
        0
      ],
      "name": "Preeyal Patel"
    },
    {
      "affs": [
        0
      ],
      "name": "Meera Patel"
    },
    {
      "affs": [
        0
      ],
      "name": "Sara Haddad"
    },
    {
      "affs": [
        2
      ],
      "name": "Scott Robertson"
    },
    {
      "affs": [
        3
      ],
      "name": "Michael Menefee"
    },
    {
      "affs": [
        3
      ],
      "name": "Khaled Aref Hassan"
    },
    {
      "affs": [
        3
      ],
      "name": "Marc A. Shapiro"
    },
    {
      "affs": [
        3
      ],
      "name": "James Stevenson"
    },
    {
      "affs": [
        3
      ],
      "name": "Alex A Adjei"
    },
    {
      "affs": [
        3
      ],
      "name": "Lukas Delasos"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Moaath K. Mustafa Ali",
      "orcid": "0000-0003-3289-2333"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3k1d51326p1e2.bib",
  "cited_by": 1,
  "doi": "10.1186/s12885-026-16590-2",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13715120/",
  "id": "3k1d51326p1e2",
  "issns": [
    "1471-2407"
  ],
  "landing_url": "https://doi.org/10.1186/s12885-026-16590-2",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2740|Lung Cancer Treatments and Mutations"
    ]
  ],
  "openalex": "W7172020527",
  "pdf_url": null,
  "pmcid": "PMC13715120",
  "pmid": "42947053",
  "published": "2026-07-31",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/3k1d51326p1e2.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T12:22:29Z",
      "native_id": "PMC13715120",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s12885-026-16590-2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Lung Cancer Treatments and Mutations",
      "subfield": "general"
    }
  ],
  "title": "Trends in treatment and survival of stage IV non-squamous NSCLC from 2010 to 2022",
  "title_text": "Trends in treatment and survival of stage IV non-squamous NSCLC from 2010 to 2022",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:22:29Z",
  "url": "https://research.draconitic.com/paper/3k1d51326p1e2",
  "venue": "BMC Cancer",
  "versions": []
}