The Therapeutic Implications of Biomarkers Testing in  Non-small Cell Lung Cancer in Middle- and Low-income  Country: The Example of Morocco

Oussama Aazzane; Sofia Fathi; Charkaoui Meryem; Acharki Abdelkader; Sahraoui Souha; Benchakroun Nadia; Fellah Hassan; Karkouri Mehdi

doi:10.31557/apjec.2024.7.1.39-46

Authors

Oussama Aazzane Laboratory of Cellular and Molecular Pathology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco. Pathology Department, Ibn Rochd University Hospital, Casablanca, Morocco. Immunology Laboratory, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco.
Sofia Fathi Laboratory of Cellular and Molecular Pathology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco. Pathology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Charkaoui Meryem Mohammed VI Cancer Treatment Center, Ibn Rochd University Hospital, Casablanca, Morocco.
Acharki Abdelkader Ryad Oncology Clinic, Casablanca, Morocco.
Sahraoui Souha Mohammed VI Cancer Treatment Center, Ibn Rochd University Hospital, Casablanca, Morocco.
Benchakroun Nadia Laboratory of Cellular and Molecular Pathology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco. Mohammed VI Cancer Treatment Center, Ibn Rochd University Hospital, Casablanca, Morocco.
Fellah Hassan Laboratory of Cellular and Molecular Pathology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco. Immunology Laboratory, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco.
Karkouri Mehdi Laboratory of Cellular and Molecular Pathology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco. Pathology Department, Ibn Rochd University Hospital, Casablanca, Morocco.

DOI:

https://doi.org/10.31557/apjec.2024.7.1.39-46

Keywords:

Non-small cell lung cancer, biomarkers, chemotherapy, targeted therapy, immunotherapy.

Abstract

Introduction: The Identification of PD-L1, EGFR and ALK status is essential to guide personalized treatment of NSCLC. The objective of our study is to evaluate the implication of changing the therapeutic protocol on the prognosis of Moroccan patients with NSCLC.

Methods: Between January 2019 and February 2023, 96 patients with NSCLC were recruited.

Results: In our population, the patients were treated with different first-line protocols: 83.34% (N=80) with neo-adjuvant chemotherapy, 14.58% (N=14) with immunotherapy and 2.08% (N=2) with targeted therapy. Of the 82 patients who received neo-adjuvant chemotherapy (N=80), 24 were able to switch to immunotherapy. While, the 2 patients who received targeted therapy beforehand also switched to immunotherapy. The influence of the number of chemotherapy (Chemo) cycles on vital status and overall survival (OS) of the 24 patients who switched from their initial protocol to immunotherapy (IO) showed that patients who received IO after completing the 4 or 5 cycles of chemo had a good OS, with a mean of 29.07 months. In comparison, patients who received less than 4 cycles of chemo had a mean OS of 14.70 months, while those who received more than 5 cycles of chemo had a mean OS of 21.38 months. Furthermore, the association between change in treatment protocol and patient vital status was significant (p=0.013). However, there was a significant difference in OS between patients who maintained the treatment protocol (mean OS=12.43 months) and those who changed the protocol (mean OS=24.01 months) (p=0.000). Multivariate analysis indicated that maintaining the initial therapeutic protocol was independently associated with a reduced OS (p=0.003).

Conclusion: Our results highlight the impact of changing the protocol on the OS of NSCLC patients taking into account the importance of choosing the right timing to switch to IO based on the number of prior chemo cures.