Multiple sclerosis and lung cancer: A single cancer center experience in Philadelphia.

Abstract

e20027 Background: The association between multiple sclerosis (MS) and lung cancer remains poorly understood. This retrospective, single center study aims to characterize the clinical features and outcomes of lung cancer in patients with MS, shedding light on this unique patient cohort characterized by immune dysregulation and significant immunosuppressive therapy. Methods: This retrospective study analyzed 40 MS patients diagnosed with lung cancer at Sidney Kimmel Cancer Center in Philadelphia, PA between 1/1/2016 and 7/1/2023. Clinical data including patient demographics, MS treatments, cancer diagnosis details (date, stage, histology), molecular and fusion data, PD-L1 status, and patient mortality dates were recorded and analyzed. Results: In our cohort of 40 patients, 28 (70.0%) patients were female, with 28 (70.0%) identifying as White and 7 (17.5%) as Black. NSCLC was seen in 37 patients (26 adenocarcinoma, 5 squamous cell carcinoma), while 3 had SCLC. Among the 33 patients with available MS treatment data, 9 (26.5%) received steroids, and 15 (44.1%) received biologic therapy. The average age at lung cancer diagnosis was 62.8 (±10.9) years, with 18 out of 40 patients (45.0%) diagnosed with stage I disease. Advanced stages were found in 22 patients (55.0%) at diagnosis: 2 (5.0%) with stage II, 1 (2.5%) with stage III, and 19 (47.5%) with stage IV disease. Among 15 patients with molecular testing, BRAF mutation was found in 1 (6.7%), EGFR mutation in 4 (26.7%), and KRAS mutation in 2 (13.3%). One subject demonstrated an ALK fusion (7.1%). PD-L1 testing was recorded in 13 patients: 3 (23.1%) had 0%, 1 (7.7%) had 1%, 5 (38.5%) had 1-49%, and 4 (30.8%) had > 50% PD-L1 expression. The average overall survival was 2.4 years (95% CI: 1.4-8.1 years). Conclusions: In this cohort, MS patients with lung cancer exhibited targetable mutations, such as EGFR mutations and high PD-L1 expression rates. While the use of immunotherapy in lung cancer with concurrent MS has been limited, our data suggests the importance of molecular profiling in all lung cancer patients. We consider that these patients received significant exposure to immunosuppressive therapies for MS, potentially impacting immune surveillance and lung cancer development. Despite this, nearly half of the cohort had Stage 1 lung cancer and showed favorable overall survival rates. Our cohort study suggests a need to investigate the relationship between MS and lung cancer further.