Non-small Cell Lung Cancer in Women: Experience From the National Institute of Oncology, Rabat, Morocco.

Introduction and aim Lung cancer is the most common cancer and the leading cause of cancer deaths worldwide; its incidence in the female population is increasing. The objective of this study was to describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary profile of female patients with non-small cell lung cancer (NSCLC) and to research the predictive factors of better survival. Methods A retrospective cohort study was carried out among women with NSCLC, diagnosed between January 2019 and December 2023, at the National Institute of Oncology, Rabat, Morocco. The diagnosis was proven by pathological analysis of biopsy. Statistical analysis was carried out using Jamovi software version 2.5.3. Results We assessed 146 women (18.3%) among 805 cases with NSCLC; the average age was 63.5 ± 12.3 years. The percentage of non-smokers, passive smokers and active smokers was 87.7%, 7.5% and 4.8%, respectively. Cough (56.2%), chest pain (21.2%) and dyspnea (19.9%) were the major clinical signs. The common histological types were adenocarcinoma (90.4%), squamous cell carcinoma (6.8%) and other types (2.8%). The primary tumor site was in the right lung in 78 patients (53.4%), on the left in 65 cases (44.5%) and in three cases (2.1%) bilateral. Most patients, 87% (127 cases), were diagnosed at stage IV according to the TNM classification 8th edition.  The epithelial growth factor receptor (EGFR) mutation test performed in 79 female patients (54% of cases) was positive in 28 patients (35.4%). Mutations were predominant on exon 19 (24 patients or 86%), followed by the L858 mutation on exon 21 (four patients or 14%). The anaplastic lymphoma kinase mutation, which was sought in 65 patients (44% of cases), was positive in six patients (9.2%). The search for the reactive oxygen species (ROS1) mutation was performed in seven patients (4.7%) and was positive in one case (14.2%). Programmed death-ligand 1 (PD-L1) expression was affected in 67 patients (45.8%); it was <50% in 57 patients representing 85% of cases and ≥50% was noted in 10 patients (15%).106 stage IV female patients (72.6%) had received first-line palliative systemic treatment, including 89 cases (84%) who had received platinum-based chemotherapy (including 11 EGFR mutated) and 17 EGFR mutated (16%) received anti-EGFR treatment. In our series, the median overall survival (OS) was 17 months (12.23) and the median progression-free survival (PFS) was 11 months (6.12). Median OS of EGFR-mutated female patients treated in first-line with EGFR TKIs (tyrosine kinase inhibitors) was similar compared with that of EGFR-mutated patients treated with platinum-based chemotherapy (25 months), and median PFS in these patients was slightly longer but statistically non-significant compared with that of patients treated with platinum-based chemotherapy (9.5 months vs. 6.5 months, p=0.22). Conclusion The population of women with NSCLC studied was characterized by non-smoking, adenocarcinoma histological type dominance, and a high percentage of EGFR mutations. The median PFS of patients treated with EGFR TKIs was slightly longer than that of patients who received platinum-based chemotherapy. These results encourage us to perform EGFR mutation testing in all patients diagnosed with adenocarcinoma so that they can receive targeted therapy with EGFR TKIs.