Disparity in oncology therapy access and differences in clinical pathological features and outcomes in indigenous population lung cancer (LC): A retrospective study from Martinique.
Authors: Moranton Marlyne , Colomba Emeline , Serag Mounir , Zouzou Adel , Boukadoum Nassim , Noly Lauriane , Lekhal-Bouamama Amina , Randriamiarisoa Heriniaina Daddy , Rakotonarivo Jean-Marc , Bougas Stefanos , Fard Karim , Masson Soizic , Drame Moustapha , Marlin Régine , Hustache-Castaing Romain , Aldea Mihaela , Agossou Moustapha 
Published: May 2024

1599 Background: The epidemiology of cancers in terms of incidence and mortality are different in the French overseas compared to mainland France (FRANCIM 2019 data). Indigenous population are under-represented in clinical trials. Little is known about clinic-pathological features and outcomes from Caribbean islands. We report clinico-pathological features and survival in populations of patients with lung cancer (LC) and delays in access to therapy in Martinique. Methods: We conducted an academic retrospective study on patients with lung cancer (LC), treated at the University Hospital in Martinique between 2020-2022. The hospital in Martinique centralized all cancer patients in the territory for treatment. Demographic, risk factors, disease features, and treatment outcomes were collected from medical records. The molecular profile was determined using next-generation sequencing with the Archer FUSION Plex Lung v2 panel, evaluating at least EGFR, ALK, KRAS, ERBB2, MET, ROS1, BRAF, RET, NUTM1, PIK3CA, FGFR1, FGFR2, FGFR3, NRG1, NTRK1, NTRK2, NTRK3. We assessed time from symptoms to diagnosis and treatment, and overall survival (OS). Results: Overall, 268 patients (pts) were included. Pts were male in 51% cases (N=136), had a smoking history in 57% (N=139/243), with a median pack-years of 40 [IQR 22-50]. Median age was 67 years-old [IQR 58-78]. Histology was adenocarcinoma in 78% (N = 208), squamous cell in 13% (N=34), neuroendocrine tumors in 8% (N=21), and others in 2% (N=5). No small cell carcinoma diagnosed. Tumors had high PD-L1 expression (≥50%) in 18% (N=41/227) of cases. An oncogenic addiction was reported in 58% (N =105/181) of non-small cell and non-squamous lung carcinoma: EGFR36% (N=65), ALK3.3% (N=6), BRAF1.1% (N=2), KRAS13.3% (N=24). Pts had an ECOG performance status of 0-1 at diagnosis in 66% (N =162/244). LC was metastatic from diagnosis in 65% cases (N=175), with 18% having brain metastases (N=48). Median time between symptom occurrence and diagnosis was 66 days [IQR 21-171] and time between biopsy and treatment start was 56 days [IQR 31-77]. In pts with stage IV disease, 33% (N=59/175) never received a systemic treatment. In patients with at least 6 months of follow-up in the absence of death, median OS was 12.4 months (95% CI 8.6 – 17.1) overall and 8.6 months (95% CI 5.3 – 13.3) in patients with initial metastases. Conclusions: The lower overall survival rate than expected in this cancer context address the question of disparity population. One-third of LC metastatic patients did not receive systemic therapy. The local inadequacy of care pathways, leading to disparities in access to imaging, may explain the delays and poorer prognosis. A new initiative from a collaborative group with health authorities, caregivers, politicians and patient’s advocacy is actively working to improve cancer patient’s outcomes.