Unveiling the challenges of small cell lung cancer in resource-limited settings: A multicenter collaboration analysis of demographics, treatment modalities, and prognosis.
Authors: Kapoor Mayank , Sehrawat Amit , Philips Ashwin Oommen , Panda Soumya Surath , Cyriac Sunu Lazar , Rathnam Krishnakumar , Saju S V , Moharana Lalatendu , Mohanty Swati Sucharita , sundriyal Deepak , Mishra Mayank , N Sathya , Sikri Vikas , Toi Pampa Ch , Manju Rajaram , Biswajit Dubashi , Ganesan Prasanth , Paul Davis , C G Geetha 
Published: June 2024

e20103

Background: Constituting 15% of lung cancers, Small Cell Lung Cancer (SCLC) lacks comprehensive data on its characteristics and outcomes, particularly in Low-Middle-Income Countries (LMICs) like India. This study draws collaboration from six institutes under the Network of Oncology Clinical Trials of India (NOCI), a BIRAC-funded network. It delves into clinicopathological, biochemical and radiological features, treatment strategies, and outcomes of SCLC patients in LMICs. Methods: Spanning six participating institutes from 2018 to 2023, we prospectively compiled demographic and clinical data within a network cancer registry. Age, gender, addictions, comorbidities, symptomatology, biochemical and immunohistochemistry (IHC) markers, imaging characteristics, treatment strategies and outcomes, including PFS and OS, were meticulously documented. Results: A total of 73 patients with SCLC, with a median age of 63 (44-81) years were included. 85% were males, 73% smokers (62% “bidi”), 29% alcoholic, 22% hypertensive, and 15% diabetic. Cough (67%), chest pain (45%), dyspnoea (40%), and hemoptysis (15%) were the commonest presentations. Median hemoglobin was 13 gm/dL and albumin 3.6 gm/dL. IHC was available for 43 patients, which revealed 83% synaptophysin, 65% chromogranin, and 11% napsin positivity. 66% presented with extensive stage disease and 45% with lymph node involvement. 42% had contralateral lung, 30% plaural effusion, 11% liver and supraclavicular node, 10% bone, and 7% adrenal metastasis. Upfront brain imaging was done for 15 patients, and 40% had brain metastasis. 94% of patients underwent chemotherapy (none immunotherapy), 28% radiotherapy, and only 6% upfront surgery. Of the patients receiving chemotherapy, 62% were given etoposide and carboplatin, 19% etoposide and cisplatin, and 19% others, including topotecan or single-agent therapy (mean three cycles). 13% had significant chemotherapy-related acute toxicity. 50% revealed progression following 1st line therapy. The median duration of follow-up was 7 (1-45) months. At the last follow-up, 68% of patients had expired, with a median OS of 5.8 (95% CI 2.9-8.6) months and median PFS 4.1 (95% CI 2-6) months. Conclusions: This multicenter study involving SCLC patients in LMICs offers crucial insights into characteristics, treatment approaches, and outcomes. Results reveal alarming poor response and survival rates. The contralateral lung and adrenals were frequent sites of metastasis. Surgical options were limited, emphasizing reliance on etoposide and platinum-based regimens, with no utilization of immunotherapy. This data informs the development of primary prevention (smoking cessation), early diagnosis, more effective treatment strategies, and the need for genomic and transcriptomic analysis to understand underlying biological disparities.