A comprehensive comparison between young and older-age non-small cell lung cancer patients at a public referral centre in Delhi, India.

Vishal Vashistha,Deepali Jain,Hariharan Iyer,Anant Mohan,Karan Madan,Avneet Garg,Randeep Guleria,Vijay Hadda

doi:10.3332/ecancer.2021.1223

Abstract

PurposeGiven the increasing number of non-small cell lung cancer (NSCLC) patients in India, a comparative analysis between patients under 40 years and those of older age at a major public referral centre would provide insight into the phenotypic patterns of this group.MethodsNSCLC patients who were accessioned within the lung cancer clinic database of the Pulmonary Medicine Department at the all India institute of medical sciences – Delhi between 2008 and 2019 were reviewed. Patients 40 years or younger and 60 years or older were selected and categorised as young and older patients, respectively. Baseline clinical characteristics, histologic profiles, treatments administered and survival outcomes were compared between both groups.ResultsFollowing the database review, 154 young and 1,058 older patients were selected for inclusion. Clinically, young patients were more often female (26.0% versus 14.5%, p < 0.001), retained a more independent performance status (64.1% versus 45.5%; p < 0.001) and never smoked (63.7 % versus 18.8%, p < 0.001). Regarding disease profiles, young patients were more frequently diagnosed with adenocarcinoma (p < 0.001) and 12 young patients had adenoid cystic carcinoma. Rates of stage IV disease at presentation were higher among young patients (78.0% versus 63.0%, p < 0.001). Regarding treatment, no differences in systemic therapies administered or survival were identified.ConclusionIn India, young NSCLC patients are frequently non-smokers and diagnosed with advanced disease. Despite better performance status, young patients do not share better outcomes. Efforts should be directed towards optimising intensive treatment for young patients.

Highlights

Lung cancer remains the leading contributor to cancer-related mortality worldwide [1]
Given that providers are often ambivalent towards mild or moderate respiratory symptoms among younger patients, we proposed the following hypotheses: (1) the rate of metastatic disease would be similar to or potentially higher among young patients compared to older patients; (2) the rate of adenocarcinoma would be higher among young patients, and the rates of actionable mutations would be higher as detailed in previous reports and (3) the performance status among young patients would be better, which in turn would lead to improved treatment outcomes compared to older patients [6, 7, 10, 11]
Following the review of the Lung Cancer Clinic (LCC) database, which included 2,427 total lung cancer patients and 2,072 patients with non-small cell lung cancer (NSCLC), 154 young patients and 1,058 older patients were selected for inclusion

Summary

Introduction

Lung cancer remains the leading contributor to cancer-related mortality worldwide [1]. Research therapies and checkpoint inhibitors, for patients with metastatic non-small cell lung cancer (NSCLC). These precision therapies extend survival outcomes and occasionally provide durable responses primarily for select patients with favourable molecular profiles and/or expression of tumour biomarkers [2,3,4]. Young patients with lung cancer remain an exceedingly concerning group for providers, despite the expansion of treatment options in recent years

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