Abstract 238P
Background
Variations in oncogene-driven lung cancer incidence across populations suggest an interplay between inherent and environmental factors in its etiology. This study aimed to elucidate distinct mutational patterns across geographic districts in Israel and delineate patient characteristics.
Methods
Employing Clalit Healthcare Services’ computerized database, encompassing over half of the national populace, this retrospective cohort study comprised individuals diagnosed with primary lung carcinomas from Jan 2012 to Dec 2023. Oral drug acquisitions from accredited pharmacies served as proxies for mutational status, post national reimbursement. Statistical analyses profiled mutation groups by demographics, prevalence, and regional incidence trends. Controls were integrated to mitigate confounding factors, including multiple drug purchases and off-label usage.
Results
Among 58,015 subjects with lung cancer (A), 1,924 received drugs targeting EGFR mutations (E), 325 ALK/ROS1 (AR), 99 BRAF (B), 41 MET (M), 32 NTRK/ROS1 (NR), and 20 RET (R). Females constituted 35.9% (A), notably higher in certain groups (68.8% NR, 60% R, 58.5% E, 51.7% AR, 42.7% B, 39% M, p<0.001). Mean age was 68 years (A) and ranged from 61 (AR) to 76 (M), differing across groups (p<0.001). When considering mutations collectively, compared with all subjects, higher socioeconomic status was observed (24.0% v 16.4%, p<0.001), while less smoking history seen in R, NR, AR, E, in ascending order (p<0.001). Moreover, E, AR were associated with fewer comorbidities, whereas B, M with more (p<0.001). Significant regional disparities were prominent, with Jerusalem displaying highest E prevalence, while AR, NR more frequent in peripheral compared with central districts. Temporal incidence rates indicated a trend towards reduction in E in northern regions and a rise in AR across districts. In 2023, one year post all drug approvals, incidence comprised E (70%), AR (11%), B (6%), M (6%), R (4%), NR (2%).
Conclusions
Varied mutational patterns discerned among different regions within the country necessitate a deeper investigation into individual patient data and socioenvironmental exposures, in order to identify potential risk factors and impact preventative and interventional strategies.
Clinical trial identification
Institutional regulatory approval for Emek Medical Center PI: Ilit Turgeman EMC-0163-22 15 DEC 2022.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.