Download PDF
CC BY-NC-ND 4.0 · South Asian J Cancer 2021; 10(03): 175-182
DOI: 10.1055/s-0041-1733312
Original Article: Lung Cancer

Challenges in the Management of Lung Cancer: Real-World Experience from a Tertiary Center in South India

Vishnu Gopal
1   Department of Medical Oncology, JIPMER, Puducherry, India
,
Biswajit Dubashi
1   Department of Medical Oncology, JIPMER, Puducherry, India
,
Smita Kayal
1   Department of Medical Oncology, JIPMER, Puducherry, India
,
Prasanth Penumadu
1   Department of Medical Oncology, JIPMER, Puducherry, India
,
Manju Rajaram
1   Department of Medical Oncology, JIPMER, Puducherry, India
,
Gunaseelan Karunanithi
1   Department of Medical Oncology, JIPMER, Puducherry, India
,
Subathra Adithan
1   Department of Medical Oncology, JIPMER, Puducherry, India
,
Pampa Ch Toi
1   Department of Medical Oncology, JIPMER, Puducherry, India
,
Prasanth Ganesan
1   Department of Medical Oncology, JIPMER, Puducherry, India
› Author Affiliations Funding The study was supported by Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER). No grant number is applicable. There were no external sources of funding for this project.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Lung cancer is one of the most common cancers and an important cause of cancer-related mortality. Recent advances in targeted therapy and immunotherapy have improved outcomes, but these have limited penetration in resource-constrained situations. We report the real-world experience in treating patients with lung cancer in India. A retrospective analysis of baseline characters, treatment and outcomes of patients with lung cancer seen between January 2015 to December 2018 (n = 302) at our center was carried out. Survival data were censored on July 31, 2019. A total of 302 patients (median age: 57 years [range, 23–84 years]; males [n = 203; 67.2%]) were registered. Adenocarcinoma was the most common histology (n = 225, 75%). The testing rate of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutation analysis in stage IV adenocarcinoma (n = 191) was 67% and 63%, respectively. Systemic therapy (chemotherapy/gefitinib) was started after a median of 62 days (range, 1–748) from presentation and 38 days (range, 1–219 days) from diagnosis. The median progression-free survival (PFS) and overall survival (OS) were 4.3 months (95% CI, 3.2–5.4) and 9.0 months (95% CI, 7.6–10.5), respectively in the 141 patient without targetable mutations who started palliative chemotherapy. Of the 58 patients who tested positive for EGFR mutation, 41 (71%) started an EGFR tyrosine kinase inhibitor (TKI), and the median PFS and OS in these patients were 8.5 months (95% CI, 5.6–11.4) and 18.4 months (95% CI, 12.2–24.6), respectively. Only 1 out of 10 patients with stage IV ALK-positive adenocarcinoma was started on ALK inhibitor. On multivariate analysis of OS for patients who started on palliative chemotherapy, response to first-line treatment, long distance from the center, use of second line therapy, and a delay of > 40 days from diagnosis to treatment predicted improved survival. Despite providing free diagnostic and treatment services, there was considerable delay in therapy initiation, and a significant proportion of treatment noninitiation and abandonment. Measures should be taken to understand and address the causes of these issues to realize the benefits of newer therapies The apparent paradox of improved survival in those with long delay in initiation of treatment could be explained based on a less aggressive disease biology.

Keywords

Lung cancer - Chemotherapy - targeted therapy - outcomes - delay in treatment


Publication History

Article published online:
20 December 2021

© 2021. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424
    CrossrefPubMedGoogle Scholar
  • 2 Malik PS, Raina V. Lung cancer: prevalent trends & emerging concepts. Indian J Med Res 2015; 141 (01) 5-7
    CrossrefPubMedGoogle Scholar
  • 3 Yuan M, Huang L-L, Chen J-H, Wu J, Xu Q. The emerging treatment landscape of targeted therapy in non-small-cell lung cancer. Signal Transduct Target Ther 2019; 4 (01) 61
    CrossrefPubMedGoogle Scholar
  • 4 Behera D. SC17.03 Lung cancer in India: challenges and perspectives. J Thorac Oncol 2017; 12 (01) S114-S115
    CrossrefGoogle Scholar
  • 5 Parikh PM, Ranade AA, Govind B. et al Lung cancer in India: current status and promising strategies. South Asian J Cancer 2016; 5 (03) 93-95
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Murali AN, Radhakrishnan V, Ganesan TS. et al Outcomes in lung cancer: 9-year experience from a tertiary cancer center in India. J Glob Oncol 2017; 3 (05) 459-468
    CrossrefPubMedGoogle Scholar
  • 7 Malik PS, Sharma MC, Mohanti BK. et al Clinico-pathological profile of lung cancer at AIIMS: a changing paradigm in India. Asian Pac J Cancer Prev 2013; 14 (01) 489-494
    CrossrefPubMedGoogle Scholar
  • 8 Blanchon F, Grivaux M, Asselain B. et al 4-year mortality in patients with non-small-cell lung cancer: development and validation of a prognostic index. Lancet Oncol 2006; 7 (10) 829-836
    CrossrefPubMedGoogle Scholar
  • 9 Cetin K, Ettinger DS, Hei Y-J, O’Malley CD. Survival by histologic subtype in stage IV nonsmall cell lung cancer based on data from the Surveillance, Epidemiology and End Results Program. Clin Epidemiol 2011; 3: 139-148
    CrossrefPubMedGoogle Scholar
  • 10 Khan NA, Afroz F, Lone MM, Teli MA, Muzaffar M, Jan N. Profile of lung cancer in Kashmir, India: a five-year study. Indian J Chest Dis Allied Sci 2006; 48 (03) 187-190
    PubMedGoogle Scholar
  • 11 Doval DC, Sinha R, Batra U, Choudhury KD, Azam S, Mehta A. Clinical profile of nonsmall cell lung carcinoma patients treated in a single unit at a tertiary cancer care center. Indian J Cancer 2017; 54 (01) 193-196
    CrossrefPubMedGoogle Scholar
  • 12 Mohan A, Latifi AN, Guleria R. Increasing incidence of adenocarcinoma lung in India: Following the global trend?. Indian J Cancer 2016; 53 (01) 92-95
    CrossrefPubMedGoogle Scholar
  • 13 Thun MJ, Henley SJ, Burns D, Jemal A, Shanks TG, Calle EE. Lung cancer death rates in lifelong nonsmokers. J Natl Cancer Inst 2006; 98 (10) 691-699
    CrossrefPubMedGoogle Scholar
  • 14 Wakelee HA, Chang ET, Gomez SL. et al Lung cancer incidence in never smokers. J Clin Oncol 2007; 25 (05) 472-478
    CrossrefPubMedGoogle Scholar
  • 15 Rajappa S, Gundeti S, Talluri MR, Digumarti R. Chemotherapy for advanced lung cancer: a 5-year experience. Indian J Cancer 2008; 45 (01) 20-26
    CrossrefPubMedGoogle Scholar
  • 16 Kaur H, Sehgal IS, Bal A. et al Evolving epidemiology of lung cancer in India: Reducing non-small cell lung cancer-not otherwise specified and quantifying tobacco smoke exposure are the key. Indian J Cancer 2017; 54 (01) 285-290
    CrossrefPubMedGoogle Scholar
  • 17 Chandra S, Mohan A, Guleria R, Singh V, Yadav P. Delays during the diagnostic evaluation and treatment of lung cancer. Asian Pac J Cancer Prev 2009; 10 (03) 453-456
    PubMedGoogle Scholar
  • 18 Annakkaya AN, Arbak P, Balbay O, Bilgin C, Erbas M, Bulut I. Effect of symptom-to-treatment interval on prognosis in lung cancer. Tumori 2007; 93 (01) 61-67
    CrossrefPubMedGoogle Scholar
  • 19 Maurer MJ, Ghesquières H, Link BK. et al Diagnosis-to-treatment interval is an important clinical factor in newly diagnosed diffuse large B-cell lymphoma and has implication for bias in clinical trials. J Clin Oncol 2018; 36 (16) 1603-1610
    CrossrefPubMedGoogle Scholar
  • 20 Ambroggi M, Biasini C, Del C Giovane, Fornari F, Cavanna L. Distance as a barrier to cancer diagnosis and treatment: review of the literature. Oncologist 2015; 20 (12) 1378-1385
    CrossrefPubMedGoogle Scholar
  • 21 Broom A, Nayar K, Tovey P. et al Indian cancer patients’ use of Traditional, Complementary and Alternative Medicine (TCAM) and delays in presentation to hospital. Oman Med J 2009; 24 (02) 99-102
    PubMedGoogle Scholar
  • 22 Elangovan V, Rajaraman S, Basumalik B, Pandian D. Awareness and perception about cancer among the public in Chennai, India. J Glob Oncol 2016; 3 (05) 469-479
    CrossrefPubMedGoogle Scholar
  • 23 Noronha V, Patil VM, Joshi A. et al Epidermal growth factor receptor positive lung cancer: The nontrial scenario. Indian J Cancer 2017; 54 (01) 132-135
    CrossrefPubMedGoogle Scholar
  • 24 Noronha V, Prabhash K, Thavamani A. et al EGFR mutations in Indian lung cancer patients: clinical correlation and outcome to EGFR targeted therapy. PLoS One 2013; 8 (04) e61561-e61561
    CrossrefPubMedGoogle Scholar
  • 25 Murthy S, Rajappa S, Gundimeda S, Mallavarapu K, Ayyagari S, Yalavarthi P. et al. Anaplastic lymphoma kinase status in lung cancers: an immunohistochemistry and fluorescence in situ hybridization study from a tertiary cancer center in India. Indian Journal of Cancer 2017; 54 (01) 231-235
    CrossrefPubMedGoogle Scholar