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Characteristics and survival of advanced non-small cell lung cancer (NSCLC) in young Black patients: a Guy’s Cancer Centre real-world study.

Research output: Contribution to conference typesPosterpeer-review

Daniel Hughes, Matthaios Kapiris, Andreja Podvez Nevajda, Chara Stavraka, Gary Cook, Debra Josephs, Sharmistha Ghosh, Elias Pintus, Spyridon Gennatas, Shahreen Ahmed, George Santis, Kimuli Ryanna, Ana Montes, Daniel Smith, Eleni Karapanagiotou, Mieke Van Hemelrijck, James Spicer, Alexandros Georgiou

Original languageEnglish
PublishedOct 2022

Documents

King's Authors

Abstract

Background:
Internationally, there is a lack of data on the clinicopathological characteristics and outcomes of Black patients with NSCLC. Grouping of minority ethnic patients, such as ‘BAME,’ in advanced NSCLC is misleading. It is established that Asian ethnicity is associated with higher rates of targetable driver mutations and improved survival compared to a White population. The data are less clear for Black patients who are significantly underrepresented in clinical trials and more so in the young population, where NSCLC itself is an uncommon diagnosis. We report the characteristics and outcomes of young patients (age
Methods:
We conducted a prospective cohort study of NSCLC patients, aged within the Guy’s Cancer Cohort framework and PPI review via King’s Health Partners.

Results:
Of 248 young NSCLC patients (median 46 years), 80% (n=199) were diagnosed with or developed metastatic disease. The cohort included 55% White (n=109), 5% Asian (n=10) and a high proportion of Black (21%, n=41) patients compared to the general UK population but representative of the local demographics of South-East
London. Ethnicity was recorded as mixed, other or unknown in the remaining cases (19%, n=39).

There were high rates of adenocarcinoma histology (78% vs 83% vs 90%) and good performance status (ECOG 0-1) at diagnosis (73% vs 72% vs 89%) in the young Black, White and Asian NSCLC populations, respectively. Never smoking status was higher in Black patients with NSCLC (37%) than White patients, however, this was comparable to Asian patients (40%). Activating EGFR mutations were detected in 27%, 13% and 40% of tumours in Black, White and Asian patients respectively. ALK or ROS1 re-arrangement were detected in 3%, 16% and 20% respectively.

Overall, 76% vs 75% vs 100% of Black vs White vs Asian metastatic NSCLC patients were treated with first-line systemic anti-cancer therapy. The median overall survival (mOS) of young NSCLC Black patients was poor (12.0 months, 95% CI 7.1 – 16.8m) and similar to White patients (9.0 months, 95% CI 6.9 – 11.2m). In Asian patients mOS was 30.5 months (10.4 – 50.6m), (across all groups, p=0.38).

Discussion:
There are differences in the rates of smoking and types of genomic drivers in young Black patients with metastatic NSCLC when compared to White and Asian patients. Despite these differences, survival was as poor in Black as in White patients. The low number of Black and Asian patients in this cohort confirms the need for a multi-centre approach to collecting such real-world data. These results further emphasise the importance of including Black patients in clinical trials and independent reporting of clinicopathological characteristics and outcomes to better understand the clinical needs of the Black population. Our centre is well placed and committed to facilitate this.

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