Abstract
Lung cancer is one of the most common cancers and an important cause of cancer-related
mortality. Recent advances in targeted therapy and immunotherapy have improved outcomes,
but these have limited penetration in resource-constrained situations. We report the
real-world experience in treating patients with lung cancer in India. 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.
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 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 patient 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,
long distance from the center, use of second line therapy, and a delay of > 40 days
from diagnosis to treatment predicted improved survival. Despite providing free diagnostic
and treatment services, there was considerable delay in therapy initiation, and a
significant proportion of treatment noninitiation 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 long delay
in initiation of treatment could be explained based on a less aggressive disease biology.
Keywords
Lung cancer - Chemotherapy - targeted therapy - outcomes - delay in treatment
