702P - Young and vulnerable: The alarming trends of lung cancer in young adults from India

Background

There is limited data on the epidemiology and outcomes in lung cancer in young adults in low and middle income countries (LMICs). The following is a single centre, retrospective real-world experience on managing young adults with lung cancer.

Methods

Data on lung cancer patients aged 40 years or younger, presenting to Cancer Institute (WIA) in Chennai between 2017 and 2022 were extracted from medical records. Progression-free survival (EFS) and overall survival (OS) were calculated using the Kaplan-Meier method.

Results

Study included 73 patients. Majority of them were females (n= 42; 57.5%). Median age was 36 years (range 23-40 years). Only 15 (20.5%) of patients were ever-smokers. Commonest histology was adenocarcinoma (n=62; 85%). Fifty-four patients (74%) had driver mutation testing reports available; of which 23 (42.6%) were EGFR mutation positive, 7 (13%) were ALK and 1 was ROS fusion positive. Most patients were stage-IV at presentation (n=61; 83.6%). First line of therapy was palliative chemotherapy (n=37; 50.7%) and/or TKIs (n=29; 39.7%). Commonest first line TKIs used was Gefitinib (n=29), including empirical initiation in 18 patients. No patient received Osimertinib in first line. Median PFS was 11.6 months (95% CI: 8.5-14.5months). Amongst the 41 patients who progressed, 16 did not receive and further therapy, 18 received 2^nd line chemotherapy, and only 6 received Osimertinib. Median follow-up was 26.5 months (95%CI- 12.9-40.1months). The median OS was 19.2 months (95%CI- 12.7-25.7months). For patients with a driver mutation, median OS was 22 months (95% CI- 16.5-27.6months). Median OS was better for patients who received TKIs with palliative chemotherapy (29.5months), than only TKI (8.1months) or only chemotherapy (16.8months).

Conclusions

Lung cancer in young adults often presents at advanced stage and is associated with a poor survival, making it a significant societal challenge as it affects individuals in their most productive years. Management in a LMICs is furthered hampered by lack of universal availability of life-saving therapy like Osimertinib, and a significant proportion of patients not receiving any therapy on progression, highlighting the urgent need for better social support and access to care.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

P. Thamaraiselvan.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.