Clinical Profiles and Survival Outcomes in Patients with De Novo Metastatic Non-small Cell Lung Carcinoma – A Real World Analysis from a Tertiary Cancer Centre

Abstract

Background: Lung cancer remains the most common cancer worldwide, accounting for 11.4% of all cancers and 18% of all cancer deaths. The age-adjusted incidence of lung cancer in India shows a rising trend since 1980s (NCDIR). Understanding the clinico-epidemiological profile is crucial to assess the impact of prevention and treatment strategies.

Methods: This study retrospectively analysed patients (>18 years) with de novo metastatic non-small cell lung carcinoma (NSCLC) treated at our centre between January 2020 to December 2022. Data on demography, disease profile, treatment and outcomes were analysed, and survival analysis done using Kaplan-Meier and Cox regression models.

Results: Total 358 patients were analysed. Mean age at diagnosis was 52 (range 24-81) years with male preponderance (77%) and 55% had history of tobacco use. Adenocarcinoma was the predominant histology (79%). Common driver mutations seen were EGFR mutation (25%; MC are EGFR exon 19 deletion and L858R point mutation), ALK gene rearrangement (4%), and ROS1 mutation (<1%). Targetted therapy with TKI was used alone in 108 patients and in combination with chemotherapy in 58 patients (total 166). The remaining 192 patients received chemotherapy alone. Response evaluation data available for 205 patients with overall response (CR+PR), disease control (CR+PR+SD) and disease progression (PD) rate were 44%, 73% and 27% respectively. With median follow-up of 37 (range 24-48) months, median progression free survival (mPFS) and overall survival (mOS) were 14 and 21 months, respectively. One- and two-year PFS rates were 42% and 10%, while OS rates were 58% and 22%, respectively. Cox-regression analysis revealed histology (Adenocarcinoma vs. SCC; p<0.001) and treatment plan (TKI alone vs. Chemo + TKI; p=.009) as key prognostic factors for disease progression. SCC was associated with a 42% increased hazard (HR 0.58, 95% CI 0.43-0.78) of progression. Median overall survival with TKI alone, chemotherapy alone and TKI plus chemotherapy were 21, 18 and 15 months, respectively (p=.789). Tobacco use showed a trend towards worse survival (p=0.071).

Conclusions: This study highlights evolving care of NSCLC in Northeast India, emphasising importance of tobacco control measures in view of trend towards worse survival in tobacco users, broader molecular testing, and improved access to targeted therapies.