Cancers (Dec 2022)

Non-Small Cell Lung Cancer (NSCLC) in Young Adults, Age < 50, Is Associated with Late Stage at Presentation and a Very Poor Prognosis in Patients That Do Not Have a Targeted Therapy Option: A Real-World Study

  • Daniel Johnathan Hughes,
  • Matthaios Kapiris,
  • Andreja Podvez Nevajda,
  • Harriet McGrath,
  • Chara Stavraka,
  • Shahreen Ahmad,
  • Benjamin Taylor,
  • Gary J. R. Cook,
  • Sharmistha Ghosh,
  • Debra Josephs,
  • Elias Pintus,
  • Spyridon Gennatas,
  • Andrea Bille,
  • Kimuli Ryanna,
  • George Santis,
  • Ana Montes,
  • Mieke Van Hemelrijck,
  • Eleni Karapanagiotou,
  • Daniel Smith,
  • James Spicer,
  • Alexandros Georgiou

DOI
https://doi.org/10.3390/cancers14246056
Journal volume & issue
Vol. 14, no. 24
p. 6056

Abstract

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(1) Background: Non-small cell lung cancer (NSCLC) in young patients is uncommon. Real-world evidence on the outcomes of these patients is limited. (2) Methods: We conducted a retrospective cohort study of young NSCLC patients, age n = 125) female, 58% (n = 145) white, 18% (n = 45) black and 4% (n = 10) Asian ethnicity. Amongst patients with a documented smoking history, 30% (n = 64) were never-smokers. Most patients had adenocarcinoma (77%, n = 191) and presented with metastatic disease (67%, n = 166). Only 31% (n = 76) had treatment with curative intent. In patients who presented or developed metastatic non-squamous NSCLC (n = 179), EGFR mutation status was known in 88% (n = 157) and mutation present in 19% (n = 34), ALK was known in 66% (n = 118) with a translocation in 10% (n = 18), ROS1 status was known in 57% (n = 102) with a translocation in 4% (n = 8), and KRAS status was known in 66% (n = 119) with a mutation in 12% (n = 22). Overall, 76% (n = 152) patients with metastatic NSCLC received first-line systemic anti-cancer therapy. Median overall survival in metastatic NSCLC was 9.0 months (95% CI 6.5–11.6 months), with superior median overall survival in those with a targeted therapy option (28.7 months) compared to those without (6.6 months; p < 0.001). (4) Conclusion: Young patients contribute a significant proportion of those presenting with lung cancer. They present with advanced stage at diagnosis and have a poor prognosis. Identification of a targeted therapy option is associated with improved survival. However, most patients do not have a known genomic driver, which is in part due to limited testing, particularly in the early years of this study period. These findings highlight the particular importance of rapid-turnaround comprehensive genomic profiling in this age group and the need to identify strategies to facilitate earlier diagnosis in young NSCLC patients.

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