Real-world treatment patterns, genomic profiling access, and survival outcomes in advanced lung adenocarcinoma: A retrospective cohort analysis from a resource-limited setting.

e20722 Background: Real-world management of advanced NSCLC in LMICs is constrained by low biomarker testing rates(PD-L1, NGS), later-line systemic chemotherapy dominance over unaffordable 2nd-generation TKIs and absent novel targeted agents. This retrospective analysis evaluates outcomes with targeted therapy utilization in an Indian real-world cohort. Methods: We performed a retrospective analysis of 200 consecutive patients diagnosed with stage III/IV lung adenocarcinoma between 2021 and 2025. Data were extracted from medical records, including demographic details, smoking history, molecular testing results (EGFR, ALK, ROS1, KRAS, TP53, others), treatment modalities (chemotherapy, targeted therapy, immunotherapy), progression status, and survival. Overall survival (OS) was defined from the date of diagnosis to the date of death or last follow-up (censored). Kaplan–Meier method was used to estimate survival curves, and the log-rank test was applied to compare survival between groups. Multivariable Cox proportional hazards models were used to identify predictors of survival. Results: Median age was 55 years, with 50.5% males and 54.8% non-smokers. Molecular profiling was performed in 76% patients; actionable mutations were identified in 65%, including EGFR-35%, ALK-15%, ROS1-6%, and others. Only 56% of mutation-positive patients received targeted therapy, 82% receiving chemotherapy only or in later lines - predominantly pemetrexed and carboplatin and immunotherapy in < 5% patients. Median OS for the entire cohort was 12.0 months (95% CI 9.8–14.2). Patients receiving targeted therapy had significantly longer median OS compared to those on chemotherapy alone (24.0 vs. 8.0 months, p < 0.001, HR 0.42, 95% CI 0.28–0.63). In Subgroup analysis : EGFR+ median OS 28 months and ALK+ 22 months. In multivariable analysis, independent predictors of improved OS included receipt of targeted therapy (HR 0.45, 95% CI 0.29–0.70). Lack of molecular testing was associated with worse OS (HR 1.85, 95% CI 1.22–2.80). Conclusions: In this real-world cohort from a resource-limited setting, access to molecular testing and targeted therapy was suboptimal but strongly correlated with improved survival outcomes. Financial barriers preventing the translation of biomarker discovery into treatment delivery, directly impacting survival. These findings underscore the urgent need for health system interventions to improve access to precision medicine for patients with advanced lung cancer worldwide.