Young Onset Lung Cancer in India: Insights Into Clinical, Demographic, and Genomic Profiles.

Background: Lung cancer (LC) is traditionally perceived as a disease primarily affecting the elderly. However, individuals under the age of 40 represent a rare subset, accounting for up to 6% of all LC cases. There is limited information about demographic, clinical, pathological, and molecular features and treatment outcomes of young-onset LC.

Methods: In this study, we have analyzed the clinical, pathological, molecular, treatment, and survival outcome data of non-small-cell lung cancer patients δ 40 years of age treated at a tertiary care center in India. Additionally, we compared the in-house genomic data of young-onset LC and late-onset LC tested on a common targeted next-generation sequencing (NGS) panel.

Results: A total of 133 patients were included, with a median age of 36 years (21-40 years). Females constituted 40.6% of total, and 79% were never smokers. Adenocarcinoma was the most common histology (85.7%), and oncogene fusions were common (ALK fusion in 34% and ROS1 in 7%). After a median follow-up of 39.2 months (95% CI 20.3-49.86), median overall survival was 26 months (95% CI 15.56-32.43) and median progression-free survival (of patients with stage 4 disease) was 6.53 months (95% CI 5.03-8.4). In-house NGS data reveals a striking enrichment of fusions (ALK and RET) in young-onset LC.

Conclusion: Young-onset LC is a unique entity with a higher prevalence of targetable genomic alterations, especially oncogene fusions. All efforts should be made to identify the targetable alterations in this enriched population and implement targeted therapy.