The clinicopathological profile and treatment outcomes of stage IV lung cancer patients treated at a tertiary cancer center in India

Gunjan Shrivastav; Sandeep Batra; Nitesh Rohatgi; Alok Gupta; Hiba Siddiqui; Devavrat Arya; Ankur Bahl; Harit Chaturvedi

doi:10.18203/2320-6012.ijrms20243355

Authors

Gunjan Shrivastav Department of Oncology, Cancer Hospital and Research Institute, Gwalior, Madhya Pradesh, India https://orcid.org/0000-0002-7942-445X
Sandeep Batra Department of Oncology, Max Super Speciality Hospital, Saket Institutional Area, Saket, New Delhi, India
Nitesh Rohatgi Department of Oncology, Fortis Memorial Research Institute, Gurugram, Haryana, India
Alok Gupta Department of Medical Oncology, Medanta Hospital, Lucknow, Uttar Pradesh, India
Hiba Siddiqui Department of Oncology, Max Super Speciality Hospital, Saket Institutional Area, Saket, New Delhi, India
Devavrat Arya Department of Oncology, Max Super Speciality Hospital, Saket Institutional Area, Saket, New Delhi, India
Ankur Bahl Department of Oncology, Fortis Memorial Research Institute, Gurugram, Haryana, India
Harit Chaturvedi Department of Oncology, Max Super Speciality Hospital, Saket Institutional Area, Saket, New Delhi, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20243355

Keywords:

Chemotherapy, Lung cancer, Progression-free survival, Quality of life, Tyrosine kinase inhibitors

Abstract

Background: Non-small cell lung cancer (NSCLC) is a devastating disease that originates from a complex combination of genetic, environmental, and lifestyle factors. A prospective study was conducted at Max Hospital, Saket, New Delhi, to assess the above factors in stage IV lung cancer patients and determine the survival rate and quality of life (QOL) parameters post-administration of the recommended first-line therapy.

Methods: The primary objective of the study was to determine progression-free survival (PFS) in stage IV lung cancer patients after receiving the first-line therapy. This study also evaluated the clinical and histopathological profile of patients, survival rate, and QOL parameters after the administration of first-line therapy, which includes chemotherapy, tyrosine kinase inhibitors (TKI), immunotherapy, and chemo-immunotherapy.

Results: The study enrolled 85 patients (63 males, 22 females) with a mean age of 64.08±10.3 years. The median PFS was 10.56 months, with a six-month survival rate of 74.3% and a one-year overall survival rate of 58.3%. Among stage IV lung cancer patients, adenocarcinoma was more common (64.71%), especially in females (86.36%) compared to males (57.14%). Out of 85 patients, 54 completed the QOL questionnaire at baseline and follow-up, showing significant improvement in QOL scores during follow-up (p<0.0001).

Conclusions: This prospective study showed improvement in PFS compared to the studies already conducted in different parts of India. A notable trend of increase in NSCLC was observed among females. Improvement in QOL scores was observed in patients who received chemotherapy and TKI as the first-line therapy.

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References

World Health Organization. Cancer. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/cancer. Accessed on 26 September 2023.

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49.

Sathishkumar K, Chaturvedi M, Das P, Stephen S, Mathur P. Cancer incidence estimates for 2022 & projection for 2025: Result from National Cancer Registry Programme, India. Indian J Med Res. 2022;156(4 and 5):598-607.

Mathur P, Sathishkumar K, Chaturvedi M, Das P, Sudarshan KL, Santhappan S, Nallasamy V, John A, Narasimhan S, Roselind FS, Icmr-Ncdir-Ncrp Investigator Group. Cancer statistics, 2020: report from national cancer registry programme, India. JCO Glob Oncol. 2020;6:1063-75.

Noronha V, Dikshit R, Raut N, Pramesh CS, Karimundackal G, Agarwal JP, et al. Epidemiology of lung cancer in India: focus on the differences between non-smokers and smokers: a single-centre experience. Indian J Cancer. 2012;49(1):74-81.

Mohan A, Garg A, Gupta A, Sahu S, Choudhari C, Vashistha V, et al. Clinical profile of lung cancer in North India: A 10-year analysis of 1862 patients from a tertiary care center. Lung India. 2020;37(3):190-7.

Murali AN, Radhakrishnan V, Ganesan TS, Rajendranath R, Ganesan P, Selvaluxmy G, et al. Outcomes in lung cancer: 9-year experience from a tertiary cancer center in India. J Glob Oncol. 2017;3(5):459-68.

Howlader N, Forjaz G, Mooradian MJ, Meza R, Kong CY, Cronin KA, et al. The effect of advances in lung-cancer treatment on population mortality. N Engl J Med. 2020;383(7):640-9.

National Comprehensive Cancer Network. version 1.2024. 2023. NSCLC. Available from: https://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf. Accessed on 27 September 2023.

Soria JC, Ohe Y, Vansteenkiste J, Reungwetwattana T, Chewaskulyong B, Lee KH, et al. Osimertinib in untreated EGFR-mutated advanced non-small-cell lung cancer. N Engl J Med. 2018;378(2):113-25.

Peters S, Camidge DR, Shaw AT, Gadgeel S, Ahn JS, Kim DW, et al. Alectinib versus crizotinib in untreated ALK-positive non-small-cell lung cancer. N Engl J Med. 2017;377(9):829-38.

Doroshow DB, Sanmamed MF, Hastings K, Politi K, Rimm DL, Chen L, et al. Immunotherapy in non-small cell lung cancer: facts and hopes. Clin Cancer Res. 2019;25(15):4592-602.

Mannion E, Gilmartin JJ, Donnellan P, Keane M, Waldron D. Effect of chemotherapy on quality of life in patients with non-small cell lung cancer. Support Care Cancer. 2014;22(5):1417-28.

Ramirez RA, Lu J, Thomas KEH. Quality of life for non-small cell lung cancer patients in the age of immunotherapy. Vol. 7, Translational Lung Cancer Research. AME Publishing Company; 2018:S149-S152.

Keung EZ, Gershenwald JE. The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care. Exp Rev Anticancer Ther. 2018;18(8):775-84.

Malik PS, Sharma MC, Mohanti BK, Shukla NK, Deo SVS, Mohan A, et al. Clinico-pathological profile of lung cancer at AIIMS: a changing paradigm in India. Asian Pac J Cancer Prevent. 2013;14(1):489-94.

Rajappa S, Gundeti S, Talluri M, Digumarti R. Chemotherapy for advanced lung cancer: a 5-year experience. Indian J Cancer. 2008;45(1):20.

Mitsudomi T, Morita S, Yatabe Y, Negoro S, Okamoto I, Tsurutani J, et al. Gefitinib versus cisplatin plus docetaxel in patients with non-small-cell lung cancer harbouring mutations of the epidermal growth factor receptor (WJTOG3405): an open label, randomised phase 3 trial. Lancet Oncol. 2010;11(2):121-8.

Rosell R, Carcereny E, Gervais R, Vergnenegre A, Massuti B, Felip E, et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2012;13(3):239-46.

Shi Y, Au JSK, Thongprasert S, Srinivasan S, Tsai CM, Khoa MT, et al. A prospective, molecular epidemiology study of EGFR mutations in Asian patients with advanced non–small-cell lung cancer of adenocarcinoma histology (PIONEER). J Thorac Oncol. 2014;9(2):154-62.

Singh R, Rohtagi N. Clinicopathological and molecular epidemiological study of lung cancer patients seen at a tertiary care hospital in northern India. South Asian J Cancer. 2017;06(04):171-5.

Doval D, Prabhash K, Patil S, Chaturvedi H, Goswami C, Vaid A, et al. Clinical and epidemiological study of EGFR mutations and EML4-ALK fusion genes among Indian patients with adenocarcinoma of the lung. Onco Targets Ther. 2015;117.