A decade of Non-Small Cell Lung Cancer management: threats and opportunities in resource-limited setting

Abstract

INTRODUCTION: Non-small cell lung cancer (NSCLC) poses significant public health challenges in Tunisia.This study analyzes patient characteristics, management, and outcomes to identify improvement areas. METHODS: This retrospective multicenter study included 924 patients diagnosed with NSCLC between 2013 and 2022. The study reviewed clinical data, pathology reports, surgical records, radiation therapy summaries, and imaging findings. The study also examined trends in management features by dividing the study period into 2012-2017 vs 2018-2022. RESULTS: Median age was 60 years, with 78.7% being male, and the average tobacco consumption was 58 pack-years. Advanced-stage disease was highly prevalent, with 91% of patients presenting at stages III or IV. The median overall survival for the entire population was 32 months, varying significantly by disease stage: 52 months for stage I, 48 months for stage II, 22 months for stage III, and 14 months for stage IV. In advanced NSCLC, survival was notably higher among patients treated with targeted therapy (44 months) and immunotherapy (20 months) compared to chemotherapy alone (9 months). Over time, there was a significant increase in multidisciplinary discussions and biomarker testing rates; however, access to concurrent chemoradiation decreased. Despite some improvement, access to targeted therapy and immunotherapy remained limited. Among tested patients, a driver mutation was identified in 45.5%, but only 54% received targeted therapy. Furthermore, only 9.8% of advanced-stage patients received immunotherapy. CONCLUSION: This study serves as a baseline for future studies and highlights critical gaps in NSCLC care in Tunisia, emphasizing the need for strategic directions to enhance outcomes.