1285P - Lung cancer in never smokers (LCINS): Clinicopathological characteristics and treatment outcomes from a university cancer centre in London

Background

The patient (pt) characteristics, risk factors, and treatment outcomes of LCINS remain poorly understood. We present data from a large UK-based bespoke LCINS clinical database.

Methods

We retrospectively collected data from electronic records and analysed outcomes of LCINS pts treated at Guy’s Cancer Centre, South East London, from 2010 until 2021.

Results

483 pts were included, which accounted for 7% of all lung cancer pts. Median age was 67 years (range 25-95), 68% of pts were female (versus 43% in smokers); 50% White, 22% Black, 16% Asian, 2% mixed race, and 10% unknown (versus 72%, 5%, 2%, 2%, 18% in smokers). 8% of pts had asthma, 2% previous tuberculosis, 1% COPD, 1% interstitial lung disease, while 7% had passive smoking and 5% known asbestos exposure. 49% were overweight. 21% of pts had a history of other cancers and 5% a first-degree family history of lung cancer. Most (64%) pts presented with stage IV disease, and 16%, 6%, and 15% with stage I, II, and III respectively. Most (80%) pts had adenocarcinoma, 9% squamous cell, and 4% small cell. 50% of pts had a driver genetic aberration, although genetic testing varied dependent on histological subtype and year of diagnosis. The commonest were EGFR, ALK, KRAS, and ROS1 aberrations found in 48%, 11%, 8%, and 5% of pts tested for each gene respectively. Out of the 174 (36%) pts with stage I-III disease, 57% had curative surgery, 39% radical (chemo)radiotherapy, and 22% adjuvant chemotherapy (CT). Of all 376 metastatic pts (64% de novo and 14% relapsed), 38% had brain metastases. A total of 81%, 45%, and 23% of metastatic pts had 1, 2, and 3 lines of systemic therapy respectively. In the 1st -line setting, 47% had a tyrosine kinase inhibitor (TKI), 40% CT, and 6% CT-immunotherapy (IO). Overall, 53% of the metastatic pts had a TKI, 52% CT, and 16% IO at any treatment line. The median overall survival was 9.2, 4.0, 3.3, and 1.4 years for stage I, II, III, and IV disease respectively.

Conclusions

LCINS spans all age groups and ethnic backgrounds. Most pts are female with limited respiratory comorbidities. Pts present with advanced adenocarcinoma with a high incidence of brain metastases and driver genetic aberrations. Strategies to improve earlier stage diagnosis in LCINS are urgently needed.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

EveryBreath Lung Cancer Support Group, Guy's Cancer Charity, National Institute for Health and Care Research.

Disclosure

C. Gousis: Financial Interests, Personal, Invited Speaker: Pfizer; Financial Interests, Personal, Stocks/Shares: Mind Medicine, Kiniksa Pharmaceuticals; Non-Financial Interests, Personal, Training, Travel and accommodation: AstraZeneca. H. McGrath: Non-Financial Interests, Personal, Other, Conference registration support: Amgen. A. Bille: Financial Interests, Personal, Speaker, Consultant, Advisor: Intuitive Surgical, BD. S. Ghosh: Financial Interests, Personal, Speaker, Consultant, Advisor: Amgen, Chugai, MSD, AstraZeneca, Pfizer, Takeda, Roche. S. Gennatas: Financial Interests, Personal, Invited Speaker, Presentations to health professionals: Amgen; Financial Interests, Personal, Invited Speaker, Presentation to health care professionals: Chugai. J. Spicer: Financial Interests, Institutional, Advisory Board, Compensation to my employer for time providing advice: Lilly, AstraZeneca, BMS, GSK, RS Oncology; Financial Interests, Personal, Stocks/Shares, Co-founder: Epsilogen; Financial Interests, Institutional, Local PI, Reimbursement for treatment of patients in trial: Achilles, Genmab, Roche, Seattle Genetics, Trizell, BergenBio, MSD, Gilead; Financial Interests, Institutional, Coordinating PI, Reimbursement for treatment of patients in trial: Starpharma, BMS, IO Biotech, RS Oncology; Non-Financial Interests, Member of Board of Directors, National strategy board: Experimental Cancer Medicine Centres; Non-Financial Interests, Member of Board of Directors, Steering Committee: British Thoracic Oncology Group; Non-Financial Interests, Advisory Role, Advice on licensing decisions for MHRA: CHM Expet Advisory Group on Oncology & Haematology. A. Georgiou: Financial Interests, Personal, Speaker, Consultant, Advisor, Honoraria-Speaker: Amgen/Takeda; Financial Interests, Personal, Speaker, Consultant, Advisor, Honoraria-Speaker/Consultancy: Merck; Financial Interests, Personal, Speaker, Consultant, Advisor, Honoraria-Consultancy: AstraZeneca; Financial Interests, Personal, Other, Conference registration support: Sanofi. All other authors have declared no conflicts of interest.