Abstract Rationale With rising life expectancy, the incidence of early-stage non-small cell lung cancer (NSCLC) among octogenarians is increasing. Yet, this population remains underrepresented in screening initiatives and clinical trials due to comorbidities and perceived surgical risk. MET exon 14 skipping, detected in ∼2% of advanced NSCLC and enriched in older patients who smoked, has been associated with adverse prognosis. However, the frequency, clinicopathologic characteristics, and surgical outcomes of octogenarians with early-stage NSCLC harboring MET exon 14 skipping mutations remain poorly defined. This study aimed to characterize their clinical profile and postoperative outcomes. Methods We analyzed data from the Initiative for Early Lung Cancer Research on Treatment (IELCART) study. Eligible patients were ≥80 years of age, with clinical stage IA NSCLC (≤30 mm; cT1a-cN0M0, 8th TNM edition) who underwent curative-intent resection after study launch in April 2016 and had genomic profiling available for the resected cancer. Cases harboring MET exon 14 skipping were identified, and their demographic, clinicopathologic, surgical, and post-treatment course were reviewed. Results Among 70 octogenarians with genomic profiling for a surgically-resected NSCLC, 9 (12.8%) harbored a MET mutation, with 6 (8.6%) being a MET exon 14 skipping mutation. The median age was 82.5 years, 4 female, 6 white, non-Hispanic, 2 were former smokers, and 4 were never-smokers. Notably, 3 of 6 cancers were detected through a lung cancer screening program.All 6 surgeries were sublobar resections (5 wedge, 1 segmentectomy).All 6 of the resected cancers were adenocarcinoma, with 4 part-solid and 2 solid. For pathologic T stage, 3 were T1mi minimally invasive adenocarcinoma, 1 was T1a lepidic-predominant adenocarcinoma, 1 was T1c acinar-predominant adenocarcinoma, and 1 was T2a acinar-predominant adenocarcinoma. None of the patients had pathologic nodal or extrathoracic metastases.5 of the 6 patients did not report recurrence or death from lung cancer. 1 patient expired due to lung cancer 33 months post-surgery. 1 patient expired due to a CVA 63 months post-surgery but otherwise had no sign of lung cancer recurrence. 4 of the 6 patients are currently alive and recurrence-free, with a median follow-up time of 68 months. Conclusion These results underscore the importance of dedicated research in older patients with early-stage NSCLC. Although MET exon 14 skipping mutations were rare, affected octogenarians appeared to achieve favorable surgical outcomes, similarly to the broader cohort. Further investigation into recurrence patterns and molecular predictors of outcome in this population is warranted. This abstract is funded by: The Simons Foundation
Zhu et al. (Fri,) studied this question.