Molecular profile and disparity of care in metastatic non small cell lung cancer in a low middle income country: A retrospective analysis.

Abstract

e20517 Background: Driver mutation analysis has transformed the treatment landscape of Non Small Cell Lung Cancer (NSCLC), but there exists a significant disparity in the availability of molecular analysis to document the presence of driver mutations and accessibility to the corresponding targeted therapy. The present study sought to explore the clinical and molecular landscape of metastatic NSCLC in an Indian population, looking at the penetrance of molecular testing along with the accessibility and receipt of appropriate targeted therapy. Methods: The present study is a one year retrospective analysis of all patients of metastatic NSCLC who underwent molecular characterisation, by means of NGS hotspot testing or a limited panel. Clinicopathological features and the molecular analysis were collated. The treatment received by the patients were documented, with a focus on the patients who had targetable mutations, on whether they received the recommended first line targeted therapy or not. Results: A total of 104 patients were included in the study. 85.6% (n=89) of the patients had molecular characterisation by NGS hot spot testing, 10.6% (n=11) had a limited panel for EGFR,ALK and ROS. 33.7% of patients had an EGFR Mutation, 9.6% had a KRAS mutation, 27.9% of the patients had a TP53 mutation, mutations in the ALK domain was seen in 8.7% of the patients. BRAF (2.9%), NRAS (1.9%),PIK3CA (3.8%), ROS1 (1%),MET exon skipping mutation (1.0%) and ERRB2 (1.0%) were other mutations observed. 25.7% of the EGFR mutated population had a concurrent TP53 mutation, one patient had the cooccurrence of an EGFR mutation and PIK3CA mutation. Two patients with ALK rearrangements had a co-occurrence of a TP53 mutation (22.2%). A total of 43 patients received targeted therapy for driver mutations. The first generation anti EGFR TKI Gefitinib remained the most commonly used molecule (20.2%). Osimertinib was used in 6.7% of the patients. <5% of the patients had access to ALK inhibitors with Crizotinib and Ceritinib being the most commonly used. Conclusions: The penetrance of NGS hot spot testing was good with 85.6% of the patients undergoing the same. There was a significant disparity in the treatment received by the patients with respect to the standard of care, with third generation anti EGFR TKIs being received by only 6.7% of the patient population. The increased prevalence of EGFR mutations in the study population was concordant with previously reported data. In light of the same, the stark disparity in the treatment received compromises survival in this patient population, our data suggests the need for different standards of care and more focused recommendations in keeping with the heterogeneity of the molecular landscape and differential accessibility to novel agents.