Real-world systemic therapy utilization and survival in synchronous metastatic solid cancer: a comprehensive nationwide analysis

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Abstract Introduction This study aimed to provide population-level survival trends during the era in which new systemic therapies transformed treatment guidelines for metastatic cancer, as well as insights on the real-world use of these treatments and associated survival. Methods Adults diagnosed with synchronous metastatic solid cancer in 2008–2022 (22 cancer types) were identified from the Netherlands Cancer Registry. Median overall survival (OS) was assessed by five-year diagnostic period. For 2018-2022, systemic therapy use in any treatment line was analyzed and survival percentiles within treatment and cancer types were estimated with Kaplan-Meier survival analyses. Results Median OS in the overall cohort (n=280,419 patients) improved from 6 to 8 months between 2008–2012 and 2018–2022. Among patients diagnosed in 2018–2022, 15% received immunotherapy, 15% targeted therapy, 29% chemotherapy and/or traditional hormone therapy only, and 39% no systemic therapy. In some cancer types, a relatively large proportion of treated patients had long-term survival (e.g., immunotherapy in melanoma: p50 = 67 months). Other cancer types had a smaller subset of treated patients (p10 and p25) with substantially better outcomes than the median (e.g., targeted therapy in NSCLC: p50 = 22 months, p10 = 96 months). Conclusion Population-level survival for patients with synchronous metastatic solid cancer has modestly improved over time. The marked survival heterogeneity within cancer and treatment types highlights both the potential and uncertainty associated with (novel) treatments. Improved prediction of treatment effects and clear communication regarding survival expectation remain critical. Presenting multiple survival scenarios over median survival alone can support decision making.

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