Early years, advanced disease: The unmet need in young adults with non-small cell lung cancer

Young adults are a minority of lung cancer (LC) patients, however, clinical presentation and cancer biology can differ. Here, we report the first German cohort study of young adults with LC.

We included patients diagnosed with LC between 2019 and 2023 at the West German Cancer Centre (University Medicine Essen) in this retrospective cohort study. For analysis of clinicogenomic baseline characteristics and overall survival (OS), patients were stratified by age at diagnosis into a young cohort (YC; n = 56, ≤45 years), an older cohort (OC; n = 2.682, >45 years) and analysed across age decades.

71 of 2.738 patients with LC (2.59 %) were ≤ 45 years old. 56/71 were diagnosed with NSCLC or SCLC. YC frequently reported no history of smoking (21 % vs. 6 %; p < 0.001). Among YC, adenocarcinoma (59 % vs. 49 %) and NSCLC not-otherwise-specified (NSCLC NOS; 27 % vs. 8.2 %) were the dominant histological subtypes (p < 0.001). Stage IV disease was significantly more common in YC (stage IV: 66 % vs. 44 %; p = 0.005) with more frequent regional lymph node involvement (N1-N3 79 % vs. 56.9 %) and extrathoracic lymph node metastases (38 % vs. 14 %; p < 0.001). Frequent targetable genomic alterations in YC included ALK translocations (21 % vs. 2.2 %; p < 0.001). YC with metastatic NSCLC had similar median OS compared to OC, although OS was improved in those with targetable alterations.

Early-onset LC is characterized by advanced disease stage, adenocarcinoma histopathology and frequent targetable genomic alterations, especially in patients without a history of smoking. Early diagnosis remains a critical unmet medical need in this subgroup of patients.