Abstract 1911P
Background
Lung cancer (LC) in young patients (pts) is uncommon. Despite a reduction in smoking prevalence, the incidence of LC in young pts in the UK remains stable. Real world evidence on the clinicopathological characteristics, management and outcomes of young pts remains sparse.
Methods
We conducted a retrospective analysis of LC pts, aged ≤ 45 years at the time of diagnosis, who were treated at Guy’s Cancer Centre, London, between April 2011-April 2020.
Results
Of 156 pts, median age 41 y (range 21-45), 53% were male, 32% never-smokers, 56% white, 15% black, 7% Asian, 7% other and 15% undeclared ethnicity. Eighty percent had non-small cell (NSCLC) histology, 14% carcinoid and 6% SCLC. Of 125 NSCLC pts (86% adenocarcinoma), 71% presented with stage IV disease, 14% stage III, with only 16% able to have curative intent surgery. A total 107 NSCLC pts presented or developed advanced disease. EGFR status was known in 88%, ALK in 74% and ROS1 in 65% of pts, with detected genomic aberrations in 20%, 24% and 11% respectively. Eighty (75%) pts had first-line systemic anti-cancer therapy (SACT). The most common regimens were: platinum doublet (44%), a TKI (26%), clinical trial (6%). A total of 45% of advanced NSCLC pts had 2nd and 17% ≥ 3rd line SACT, while 13% of pts received anti-PD-(L)1 therapy at any point. Palliative radiotherapy was common: 36% extra-cranial, 21% whole brain, 7% intracranial stereotactic. Median overall survival (OS) in advanced NSCLC was 13 months (95% CI 9.5-16.6), with clearly superior outcome in non-squamous NSCLC with a targetable aberration (30 months; 95% CI 12.5-47.5) vs those without (7 months; 4.4-9.6). Carcinoid LC was associated with younger age, median 39 y and earlier stage at diagnosis (stage I/II=86%). All patients underwent surgery, with 5% relapse rate and no associated mortality.
Conclusions
Young patients with LC are more likely to be female never-smokers, with carcinoid or adenocarcinoma. Molecular drivers are more common than the overall LC population. The majority of young NSCLC pts present with advanced disease, and those without a first line TKI option have very poor outcomes. This suggests that comprehensive molecular testing in young NSCLC pts with advanced disease should be considered at diagnosis.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust.
Funding
Has not received any funding.
Disclosure
D.J. Hughes: Research grant/Funding (institution): NanoMab Technology Limited; Honoraria (self): Novartis. E.M. Karapanagiotou: Research grant/Funding (institution): Merck. J. Spicer: Research grant/Funding (institution): Blueprint; Research grant/Funding (institution): Roche. All other authors have declared no conflicts of interest.