WCLC 2025 - Posters & ePosters-P1.17.11 Clinical and Molecular Characterization of Lung Cancer in Never-Smokers Identified Through an Incidental Nodule Program

P1.17.11 Clinical and Molecular Characterization of Lung Cancer in Never-Smokers Identified Through an Incidental Nodule Program

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This study retrospectively analyzed lung cancer cases in never-smokers identified through an incidental pulmonary nodule detection program at Real Hospital Português, Brazil, from January 2023 to December 2024. Out of 25,358 CT scans reviewed, 2,200 suspicious nodules were detected, 237 patients with nodules ≥8mm entered the program, and 80 had confirmed lung cancer—with 32.5% (26 patients) being never-smokers. The mean age of never-smokers was 65.8 years, predominantly female (77%). Nodules averaged 35.2 mm in size, with 88% solid, 8% ground-glass, and 4% part-solid morphology.<br /><br />Lung cancer stages in never-smokers varied from stage 0 (8%) to stage IV (38%), demonstrating early and advanced disease detection via incidental imaging without targeted screening protocols. Notably, molecular profiling revealed that around 50% exhibited PD-L1 expression, and actionable driver mutations were identified in a majority of tumors, especially in stage IV cases—EGFR mutations were most frequent (9 cases), followed by ALK (2), ROS1 (1), and KRAS (1). However, about 30% lacked molecular testing, underscoring gaps in diagnostic accessibility. These findings emphasize the unique biology of lung cancer in never-smokers and support the need for improved molecular diagnostics to guide targeted therapies.<br /><br />The study highlights the potential of incidental imaging in early lung cancer detection among never-smokers, providing an alternative to traditional screening strategies predominantly focused on smokers. Given the rising burden of lung cancer in never-smokers, tailored screening, diagnostic, and therapeutic approaches are essential. Support from multidisciplinary teams and collaboration with pharmaceutical partners facilitated this project, which aligns with growing evidence from international studies advocating low-dose CT and incidental nodule programs to improve outcomes for non-smoking lung cancer patients.

Asset Subtitle

José Fernando Moura

Meta Tag

Speaker José Fernando Moura

Topic Global Health, Health Services, and Health Economics

Keywords

lung cancer

never-smokers

incidental pulmonary nodule detection

CT scans

molecular profiling

PD-L1 expression

driver mutations

EGFR mutations

early detection

targeted therapies