The Study of Druggable Targets in Nonsquamous Non-Small-Cell Lung Cancer in the Middle East and North Africa
Journal of Immunotherapy and Precision Oncology
Abdul Rahman Jazieh1, Adda Bounedjar2, Fouad Al Dayel3, Shamayel Fahem3, Arafat Tfayli4, Kakil Rasul5, Hassan Jaafar6, Mohammad Jaloudi6, Turki Al Fayea7, Hatim Q Al Maghrabi8, Hanaa Bamefleh1, Khaled Al Kattan3,Blaha Larbaoui9, Taha Filali10, Hamed Al Husaini3, Yosra Ali1, in collaboration with the Arab Collaborative Hematology Oncology Group (ACHOG)11
1 King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA2 BLIDA 1 University, CHU BLIDA, Algeria
3 King Faisal Specialist Hospital and Research Center, Riyadh, KSA
4 The American University of Beirut, Lebanon
5 Weill Cornell Medical College/Hamad Medical Corporation, Qatar
6 Tawam Hospital, UAE
7 Princess Noorah Oncology Center, King Abdulaziz Medical City, Jeddah, KSA
8 King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, KSA
9 Anti Cancer Center, Oran, Algeria
10 Centre Hospitalo Universitaire Ben Badis de Constantine, Constantine, Algeria
Year of Publication:
Druggable molecular targets are very important in the management of non-small-cell lung cancer (NSCLC). The purpose of our study is to determine the pattern of testing and mutation prevalence in the Middle East and North Africa population.
Patients and Methods:
Data of consecutive patients with nonsquamous NSCLC were collected from 10 centers in five countries; Saudi Arabia, UAE, Qatar, Lebanon, and Algeria. Statistical analysis was performed to delineate the prevalence of druggable targets and other relevant information.
Five hundred and sixty-six patients were included in the study. Majority were males (78.1%) with a median age of 61 years (22–89), 50% were current or ex-smokers and 370 patients (65.4%) were Stage IV. The epidermal growth factor receptor (EGFR) testing was performed on 164 patients of all stages. EGFR mutation was detected in 30 out of 96 patients (31.3%) with metastatic disease and in 12 out of 68 patients (17.6%) with Stage I to III. Female sex (39.5% vs. 22% males, P = 0.032), Stage IV (31.2% vs. 17.6% in Stage I to III, P = 0.049), and positive immunohistochemical-TTF1 (31.4% vs. 8.7% negative, P = 0.026) were predictors of mutation on univariate analysis. The multivariate analysis showed that patients with stage IV have three times higher positivity than lower stages (odds ratio = 3.495, P = 0.036). Anaplastic lymphoma kinase fusion was present in seven out of 89 patients (7.8%) of all stages, and only three out of 52 patients (5.8%) with metastatic disease. The reasons for not performing the tests in all of the 370 patients with metastatic disease were: physicians do not know where and how to send the test (62.3%), lack of funding to perform the test (11.1%), insufficient tissue (10.1%), and other reasons (16.6%).
Only a small fraction of patients with NSCLC are tested for druggable targets and the prevalence of EGFR mutation is prevalence higher than the Western population. Overcoming the challenges of testing requires systematic plans to address education and resource allocation.