Treatment and clinical outcome of young (age 40 and younger) patients with advanced non-small cell lung (NSCLC).

Abstract

e18117 Background: NSCLC is a very uncommon in pts ≤ 40 years and is usually considered as a distinct disease, with a better prognosis compared to older pts. In recent years, third generation drugs and targeted therapies have improved survival in pts with IIIB/IV stage, achieving a 10-12 mos median survival (MS). Some studies have reported small series of young pts with NSCLC but the age cut-offs varied among studies and most of them did not address the clinical outcomes of the IIIB/IV group. The present report specifically addresses the treatment and the clinical outcomes of pts ≤ 40 years with IIIB/IV stage NSCLC treated after 2000. Methods: We reviewed all pts referred for NSCLC from 2000 to 2009 to our institutions and have selected a consecutive series of 64 pts ≤ 40 years. Twelve pts with early stage were excluded and 52 with IIIB/IV NSCLC entered this study. Pts characteristics: male/female 48%/52%; median age 37 years (range 26-40); stage IIIB/IV 4%/96%; histological type: adenocarcinoma 77%, squamous 8%, other 15%. In IV stage pts, 45 had synchronous metastases, 4 developed distant metastases after radical surgery, and the last after radiochemotherapy for locally advanced NSCLC. Metastatic sites of these pts were lung in 52%, liver in 16%, lymph nodes in 38%, brain in 24%, bone in 26%, pleural in 18%, and adrenal in 6%. Results: All but one pts (who died before therapy), received systemic treatment for their IIIB/IV disease: 37% received only one line, 33% two lines, 22% three lines, and 8% four lines. Forty-five pts received as first-line a platinum-based doublet (among them 32 were treated with cisplatin + gemcitabine and 4 received bevacizumab too), 2 a platinum-based triplet, 4 a single-agent therapy. The response rate was 33% (2 CR + 15 PR). Thirty-two pts received a second-line treatment (21 received chemotherapy. 11 TKi), 15 a third-line (10 chemotherapy, 5 TKi) and 4 a fourth-line chemotherapy. The MS is 16 mos with a 58.5% 1-y OS. Conclusions: In our experience, ≤ 40 years pts with IIIB/IV NSCLC presented a survival outcome higher than expected in the overall population, according to previously reported data. An ancillary study is ongoing to evaluate possible biomarkers as prognostic factors on available tumor samples. No significant financial relationships to disclose.