Non-small cell lung cancer in women: Experience of the National Institute of Oncology of Rabat, Morocco.

Abstract

e20633 Background: Lung cancer is the leading cause of cancer deaths worldwide; its incidence in the female population is increasing. The objective of this study was to describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of female patients with non-small cell lung cancer (NSCLC), and to research the predictive factors of better survival. Methods: A retrospective cohort study was carried out among women with NSCLC, diagnosed between January 2019 and December 2023, at the National Institute of Oncology, Rabat, Morocco. The diagnosis was proven by pathological analysis of biopsy. Statistical analysis was carried by Jamovi software version 2.5.3. Results: we collected 146 women (18.3%) with NSCLC, average age was 63.5 ± 12.3 years. The percentage of non-smokers, passive smokers and active smokers was 87.7%, 7.5% and 4.8% respectively. Cough (56.2%), chest pain (21.2%) and dyspnea (19.9%) were the major clinical signs. The common histological types were: adenocarcinoma (90.4%), squamous cell carcinoma (6.8%). Most patients 87%(127 cases) were diagnosed at stage IV according to the TNM classification 8th edition. The epithelial growth factor receptor (EGFR) mutation test performed in 79 female patients (54%) was positive in 28 patients (35.4%). The Anaplastic Lymphoma Kinase (ALK) mutation, which was sought in 65 patients (44%), was positive in six patients (9.2%). The search for the Reactive Oxygen Species (ROS1) mutation was performed in seven patients (4.7%), was positive in one case (14.2%). For Programmed Death-Ligand 1 (PDL 1) expression was <50% in 57 patients (85%) and ≥50% was noted in 10 patients (15%).106 stage IV patients (72.6%) had received first-line palliative systemic treatment, including 89 cases (84%) who had received platinum-based chemotherapy (including 11 EGFR mutated) and 17 EGFR mutated (16%) received anti-EGFR treatment. The median overall survival (OS) was 17 months [12.23] and the median progression-free survival (PFS) was 11 months [6.12]. Median OS of EGFR-mutated patients treated in first-line with EGFR TKIs (Tyrosine kinase inhibitors) was similar compared with that of EGFR-mutated patients treated with platinum-based chemotherapy (25 months), and PFS in these patients was slightly longer but statistically non-significant compared with that of patients treated with platinum-based chemotherapy (9.5 months vs. 6.5 months, p=0.22). Conclusions: The population of women with NSCLC studied was characterized by non-smoking, adenocarcinoma histological type dominance, and a high percentage of EGFR mutations. The median PFS of patients treated with EGFR TKIs were slightly longer than the patients who received platinum-based chemotherapy. These results encourage us to perform EGFR mutation testing in all patients diagnosed with adenocarcinoma so that they can receive targeted therapy with EGFR TKIs.