Challenges in the Management of Lung Cancer: Real-World Experience from a Tertiary Center in South India

Vishnu Gopal , Biswajit Dubashi , Smita Kayal , Prasanth Penumadu , Manju Rajaram , Gunaseelan Karunanithi , Subathra Adithan , Pampa Ch Toi , Prasanth Ganesan

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Aim: To report the real-world experience in treating patients with lung cancer in India.

Methods: A retrospective analysis of baseline characters, treatment, and outcomes of patients with lung cancer seen between January 2015 to December 2018 (n = 302) at our center was carried out. Survival data were censored on July 31, 2019.

Results: A total of 302 patients (median age: 57 years [range, 23–84 years]; males [n = 203; 67.2%]) were registered. Adenocarcinoma was the most common histology (n = 225, 75%). The testing rate of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutation analysis in stage IV adenocarcinoma (n = 191) was 67% and 63%, respectively. Systemic therapy (chemotherapy/gefitinib) was started after a median of 62 days (range, 1–748) from the presentation and 38 days (range, 1–219 days) from diagnosis. The median progression-free survival (PFS) and overall survival (OS) were 4.3 months (95% CI, 3.2–5.4) and 9.0 months (95% CI, 7.6–10.5), respectively in the 141 patients without targetable mutations who started palliative chemotherapy. Of the 58 patients who tested positive for EGFR mutation, 41 (71%) started an EGFR tyrosine kinase inhibitor (TKI), and the median PFS and OS in these patients were 8.5 months (95% CI, 5.6–11.4) and 18.4 months (95% CI, 12.2–24.6), respectively. Only 1 out of 10 patients with stage IV ALK-positive adenocarcinoma was started on ALK inhibitor. On multivariate analysis of OS for patients who started on palliative chemotherapy, response to first-line treatment, a long distance from the center, use of second-line therapy, and a delay of > 40 days from diagnosis to treatment predicted improved survival.

Conclusion: Despite providing free diagnostic and treatment services, there was considerable delay in therapy initiation and a significant proportion of treatment non-initiation and abandonment. Measures should be taken to understand and address the causes of these issues to realize the benefits of newer therapies The apparent paradox of improved survival in those with the long delay in initiation of treatment could be explained based on less aggressive disease biology.

©2023 Subathra Adithan