Clinical characteristics and first-line palliative treatment patterns in 3,414 patients with advanced lung cancer in India

Lung cancer, particularly non-small-cell lung cancer (NSCLC), is a major global health issue. In India, the complexity of managing this disease is heightened by diverse demographics, varying healthcare access and evolving epidemiological trends influenced by factors such as smoking and advancements in diagnostics. This study explores cancer demographics and first-line palliative treatment options. We conducted a retrospective analysis of 3,414 advanced lung cancer patients planned for palliative systemic therapy at our centre between March 2000 and June 2017. The mean age of the cohort was 56.7 interquartile range (IQR: 21-88) years with a male predominance (71.9%). Histological subtypes included adenocarcinoma (82.9%), squamous cell carcinoma (13.6%) and others (3.5%). Intrathoracic metastases were seen in 40.7% and intrathoracic and extrathoracic in 37.7% of patients. The extrathoracic sites were skeletal (32.5%), liver (14.4%), brain (13.7%) and adrenal gland (9.0%). The baseline Eastern Cooperative Oncology Group Performance status was 0 (8.3%), 1 (58.7%), 2 (20.7%), 3 (11.7%) and 4 in 0.6% of the patients. Epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) positivity rates were lower in smokers. Most patients (92.4%) received the first-line systemic therapy, predominantly platinum-based doublets (67.1%). Tyrosine kinase inhibitors were given to 51.8% of EGFR+, 48% of ALK+ and 54.1% of mutation-negative cases. This study provides crucial insights into lung cancer demographics and treatment patterns at a single tertiary care centre in India, highlighting an increase in female lung cancer cases, steady smoking rates and improved access to genetic testing and targeted therapies.