Second malignancy in advanced or recurrent non-small cell lung cancer after the advent of molecular targeted drugs and immunotherapy

ObjectivesThis study aimed to investigate the characteristics of patients with recurrent or advanced non-small cell lung cancer (NSCLC) treated with tyrosine kinase inhibitors (TKIs) or immune-checkpoint inhibitors (ICIs) who developed secondary malignancies, as well as evaluate the impact of these secondary malignancies on the course of lung cancer.Materials and MethodsThis study included 112 patients with postoperative recurrent or advanced NSCLC, who received TKIs, ICIs, or immune combination therapy as the primary treatment modality between April 1, 2013, and March 31, 2020, and achieved long-term survival (>= 2 years). Secondary malignancies were defined as newly diagnosed cancers in other organs occurring after NSCLC treatment initiation.ResultsAmong the 112 patients, 10 (8.9%) developed 12 carcinomas, including third primary malignancies. Univariate analysis, considering secondary malignancies as the outcome, revealed a non-significant trend towards a higher incidence of secondary malignancies in smokers compared to non-smokers.ConclusionThis study found that 8.9% of patients with advanced NSCLC who received TKIs, ICIs, or immune combination therapy and survived >= 2 years developed secondary malignancies. This underscores the importance of early diagnosis and treatment, even during lung cancer treatment, to identify suspicious lesions in other organs either via imaging or physical examinations. The advent of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) for the treatment of advanced non-small cell lung cancer has resulted in an increasing number of long-term survivors. Consequently, the emergence of second malignancy may have implications for their prognosis. This study found that 8.9% of patients with advanced NSCLC who received TKIs, ICIs, or immune combination therapy and survived >= 2 years developed second malignancy. It was suggested that by performing screening and examinations for the second malignancy, both malignancies could be controlled. image