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ADULTS With NSCLC More Likely to Get Advanced Disease Diagnosis

VIENNA — Younger adults (ages under 50) with non-small cell lung cancer (NSCLC) were a lot more likely than older adults to be identified as having advanced disease, a researcher said here.

In 2018, 5 years following the U.S. Preventive Services Task Force recommended low-dose CT lung cancer screening (LCS) for folks over age 55 — lowered to age over 50 in 2021 — with certain risk factors, 64% of patients ages 20-49 with NSCLC were identified as having stage IV disease versus 43% ages 50-79, for a complete difference of 21%, reported Chi-Fu Jeffrey Yang, MD, of Massachusetts General Hospital in Boston.

That absolute difference was substantially higher than the 13% difference seen in 2010, when 60% of younger patients were identified as having stage IV disease versus 47% of older patients, he said in a presentation at the World Conference on Lung Cancer (WCLC).

“Different tumor biology, delays in diagnosis, and the lack of solutions to facilitate early detection of lung cancer among adults likely plays a part in the higher rate of stage IV disease diagnosed in this population,” said Yang at a WCLC press briefing.

However, WCLC discussant Anand Devaraj, MD, of Royal Brompton Hospital, Imperial College in London, cautioned that “it isn’t possible to find out whether this stage shift is directly due to screening — there could be other factors involved.”

In 2021, the duty force revised its LCS recommendation for all those ages 50-80 who’ve a 20 pack-year smoking history and currently smoke, or people with quit within days gone by 15 years. The recommendation also states that “Screening ought to be discontinued once one has not smoked for 15 years or develops a medical condition that substantially limits life span or the power or willingness to possess curative lung surgery.”

“What this data [from Yang’s group] prompted me to take into account may be the challenge most of us face … that is how exactly to identify high-risk participants in groups that can’t be easily accessed, which is not only younger patients, but additionally older patients without sufficient risk factors predicated on current risk models,” Devaraj said.

Yang and colleagues used the Surveillance Epidemiology FINAL RESULTS (SEER) database and the National Cancer Database to recognize patients, ages 20-79, identified as having NSCLC from 2010-2018. Throughout that period 1,038, 5,682, and 39,323 individuals ages 20-29, 30-39, and 40-49, respectively, were identified as having NSCLC.

The authors observed that with increasing age, the percentage of patients identified as having stage I NSCLC rose as time passes, as the percentage of patients identified as having stage IV cancer decreased. Specifically, they discovered that among younger adults, 8% of patients (ages 20-29) were identified as having stage I disease, while 76% were identified as having stage IV disease. The percentage of patients in the 30-39 and 40-49 age ranges identified as having stage I disease slightly risen to 10% and 14%, respectively, as the percentage of patients identified as having stage IV disease in those age ranges declined, but was still high at 70% and 60%, respectively.

On the other hand, 29% of patients (ages 70-79) were identified as having stage I disease and 40% were identified as having stage IV disease.

Yang and his colleagues also viewed survival data and discovered that while there is no improvement in early diagnosis among adults, median overall survival (OS) of adults identified as having NSCLC did increase by 14 months from 2010-2018, largely because of improvements in survival for patients with advanced disease.

“Notably, these improvements in median overall survival may actually align with the NCCN [National Comprehensive Cancer Network] recommendation for genetic testing for EGFR and ALK mutations in 2012, and also the FDA’s of immunotherapies in 2015,” Yang said.

However, Yang and colleagues discovered that the youngest patients (ages 20-29) identified as having NSCLC had the cheapest 5-year survival rates at 20% versus 5-year OS rates which range from 24% for older patients (ages 70-79) to 28% for middle-age patients (40-49). Moreover, 5-year OS for patients identified as having stage IV disease was particularly lower in all younger age ranges (11%, 15%, and 10% for patients in the 20-29, 30-39, and 40-49 age ranges, respectively).

Study limitations included that proven fact that it didn’t include data regarding disease-free or recurrence-free survival, tumor biomarkers, the usage of targeted therapy, or enough time from initiation presentation to lung cancer diagnosis.

Yang noted that “these improvements in median survival seen in young adults identified as having lung cancer are encouraging,” but his group stressed that ways of raise the early detection of lung cancer among younger patients, that are generally ineligible for LCS, are “urgently needed.”

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    Mike Bassett is really a staff writer concentrating on oncology and hematology. He could be located in Massachusetts.

Disclosures

Yang disclosed no relationships with industry.

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