P2.11-07 Lung Cancer in a Tertiary Care Setting: So Near, Yet So Far

Abstract

Lung cancer patients usually present in advanced stage. Once diagnosed, these patients do not take treatment/tend to leave it in-between, because of various financial and psychosocial problems, and issues related to administration of chemotherapy and side effect profile. If diagnosed at an early stage, lung cancer has a high overall 5 year survival. In developing countries, with a high burden of lung cancer and its associated morbidity and mortality, there is a need to screen the ‘at risk’ population, thus facilitating early diagnosis. Lung cancer patients were hence studied at presentation and followed up to 10-12 weeks after diagnosis. The utility of a biomarker, Heat shock protein 90-beta (Hsp 90-beta) was assessed along with. 60 individuals were included: 20 histologically/cytologically proven patients of lung cancer before treatment initiation(Group A), 20 patients with benign lung diseases(Group B) and 20 apparently healthy individuals(Group C). After thorough investigations and staging (TNM classification), patients of Group A were administered chemotherapy (NCCN guidelines), and followed up to 10-12 weeks after diagnosis. Also, 5ml of venous blood was collected from all individuals for Hsp90-beta evaluation by ELISA. In Group A, 1/20 patient was diagnosed with stage 3, rest 19/20 patients were diagnosed with stage 4 lung cancer. Predominant histopathological type was squamous cell carcinoma (14/20 patients), followed by adenocarcinoma (4/20) and small cell carcinoma (2/20). At follow up, 35% (7/20) patients were dead/lost to follow up. 13 patients were given chemotherapy, 10/13had partial response and 3/13 had progressive disease (RECIST Criteria). The 3groups were age and gender matched. Mean serum Hsp90-beta levels were 242.850, 129.825 and 107.150ng/ml in group A,B and C respectively. Group A had significantly higher levels (p<0.0005, cut off value: 146.5ng/ml, 95%sensitivity and specificity). The levels did not differ with histological type/stage of cancer. At follow up, in 13 patients of Group A, mean Hsp90-beta levels showed an increase. Majority of the patients presented in stage 4 signifying the urgent need of a diagnostic/screening tool for detection in early stages. Also, various factors which could be responsible for a high attrition rate due to death/lost to follow up need to be studied, so that specific interventions can be planned. Serum Hsp90-beta could be a valuable biomarker in diagnosis/screening of lung cancer. However, its prognostic role needs elucidation. Detailed studies with larger sample size, different histologies and different stages are required to establish various strategies for early diagnosis and timely comprehensive management, so as to drive the final treatment outcomes in a positive direction.