Abstract
BACKGROUND: Lung cancer with progressive bone metastases usually leads to skeletal-related events (SREs) and a reduced quality of life. Denosumab delays the onset of SREs and is associated with improved overall survival. However, other factors associated with overall survival in patients with lung cancer and bone metastases remain unclear. This study aimed to evaluate the survival benefit of denosumab use in patients with lung cancer and bone metastases and how other factors affect overall survival in these patients. METHODS: This retrospective cohort study included 622 patients with lung cancer treated at a southern Taiwan Medical Center between 2018 and 2022. The overall survival of patients with lung cancer and bone metastases treated with denosumab (n=90) was compared with that of patients who did not receive denosumab (n=212). Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate the factors associated with the overall survival of these patients. RESULTS: Denosumab use was associated with improved overall survival among patients with lung cancer and bone metastases compared with untreated patients (HR 0.61, 95% CI 0.47 to 0.80, p<0.001, overall survival 455 days vs 172 days), particularly in patients who had received more than five cycles of treatment (HR 0.31, 95% CI 0.19 to 0.50, p<0.001). Systemic cancer treatments, such as tyrosine kinase inhibitors, chemotherapy and immunotherapy, were also associated with improved overall survival in these patients. CONCLUSIONS: Denosumab usage, especially good compliance, for over five cycles in patients with lung cancer and bone metastases was associated with improved overall survival. Future studies should focus on strategies to improve adherence to denosumab treatment and maximise its clinical benefits.