Predictors of Multidisciplinary Tumor Board Adherence in Stage III Non-Small-Cell Lung Cancer Patients From a Large Multicenter Study.

Background: While formalized treatment recommendations for non-small cell lung cancer (NSCLC) by a multidisciplinary tumor board (MDT) have been associated with improved patient care and potentially improved survival, there is no data on the prognostic impact of individual adherence to initial MDT treatment recommendations in patients (pts) with stage III NSCLC.

Patients and methods: Multimodal treatment data for stage III NSCLC pts between 2014 and 2020 were collected from 3 Swiss referral centers. All pts underwent MDT before treatment. MDT-adherence was defined as implementation of the initially recommended treatment modalities and their sequence. Event-free survival (EFS) (primary endpoint) and overall survival (OS) were subjected to Kaplan-Meier analysis, MDT adherence to multivariable Cox regression analysis.

Results: Adherence to initial MDT recommendations was found in 385/547 (70.4%) eligible pts. Treatment de-escalation was the prominent feature in 109/162 (67.3%) non MDT-adherent pts, resulting in 89/547 (16.3%) pts receiving non-curative treatment. Pts ≥ 65 years of age had an increased risk for MDT nonadherence (32.8% vs. 23.0%, P = .02), as had pts with a higher tumor stage (19.8% for IIIA, 38.5% for IIIB, 43.3% for IIIC, P < .001) and frail (ECOG ≥ 2) pts (53.7% vs. 22.8%, P < .001). Median EFS was higher in MDT-adherent pts (11.9 months vs. 8.6 months (mo), P = 0.003), as was OS (20.3 mo vs. 9.4 mo, P < .001).

Conclusions: One third of stage III NSCLC pts is unable to adhere to initial MDT recommendations even in tertiary referral centers. Nonadherence was associated with worse outcome. Treatment strategies for vulnerable pts should critically be reviewed.