Mutation Analysis of Advanced Non-Small Cell Lung Cancer: A Retrospective Observational Study from South India

Abstract Lung cancer is a leading cause of cancer-related mortality worldwide, with non-small cell lung cancer (NSCLC) being the predominant type. Comprehensive genomic profiling plays a crucial role in identifying actionable mutations to guide personalized treatment strategies, especially in regions like India where late-stage diagnoses are common. This retrospective observational study aimed to determine the prevalence of actionable mutations in patients with advanced NSCLC from a tertiary cancer care center in South India. A retrospective observational study was conducted at the Department of Medical Oncology, Government Medical College, Kozhikode, South India. The study included 50 histologically confirmed patients with advanced NSCLC who underwent molecular testing between November 2022 and July 2024. Among the 50 patients, adenocarcinoma was the predominant histological subtype (70%), with TP53 and EGFR mutations found in 42 and 34%, respectively. Co-mutations, including TP53 + EGFR exon 19 deletions, were observed in 4% of cases. Low PD-L1 expression (<1%) was identified in 78% of patients, suggesting limited eligibility for single agent immunotherapy. Comprehensive genomic profiling is largely inaccessible to most patients in India due to high costs, but targeted next-generation sequencing (NGS) panels offer a cost-effective way to optimize treatment. This study highlights the heterogeneity of mutations in NSCLC in South Indian patients and showcases the importance of targeted NGS panels in optimizing therapeutic strategies.