WCLC 2025 - Posters & ePosters-P1.17.39 Clinical Predictive for Early Mortality in Stage IV Lung Cancer Without Targetable Mutations From Country With High Smoking Prevalence

P1.17.39 Clinical Predictive for Early Mortality in Stage IV Lung Cancer Without Targetable Mutations From Country With High Smoking Prevalence

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This retrospective cohort study at King Hussein Cancer Center assessed early mortality predictors in stage IV non-small cell lung cancer (NSCLC) patients lacking targetable ALK or EGFR mutations, from 2017 to 2024. Among 721 patients (median age 60 years; predominantly male smokers), 41.2% died within three months of diagnosis. Key factors associated with early death included older age (median 62.3 vs. 59.1 years), poor performance status (PS 3-4: 34.6% vs. 10.7%), adrenal metastases (38.7% vs. 24.5%), hyponatremia, and congestive heart failure. PD-L1 expression ≥50% and presence of adrenal metastases reflected aggressive disease biology and higher tumor burden.<br /><br />Treatment modalities influenced early mortality; immune checkpoint inhibitor (ICI) monotherapy had higher early death rates (36.9%) compared to platinum-based chemotherapy (23.3%) or combination therapies. Most deaths occurred in the hospital setting (78.8%), with a higher proportion of early deaths in intensive care units compared to general wards.<br /><br />Early palliative care involvement was linked to reduced treatment- and comorbidity-related mortality (5.4% vs. 10.9% and 5.7% vs. 10.0%, respectively), fewer ICU admissions, and better resource utilization. The majority of deaths (85.3%) resulted from disease progression, reinforcing the aggressive nature of advanced NSCLC without targetable mutations.<br /><br />The study underscores the importance of early identification of high-risk patients based on age, ECOG performance status, PD-L1 levels, and metastatic patterns to tailor management. Integrating early palliative care with individualized treatment planning is crucial in improving survival and quality of life, especially in countries with high smoking prevalence and late-stage cancer presentation.<br /><br />In conclusion, this research highlights significant early mortality in de novo metastatic NSCLC without targetable mutations and advocates for risk-adapted strategies and early palliative interventions to reduce avoidable deaths and optimize patient outcomes.

Asset Subtitle

Anas Zayed

Meta Tag

Speaker Anas Zayed

Topic Global Health, Health Services, and Health Economics

Keywords

stage IV non-small cell lung cancer

early mortality predictors

ALK and EGFR negative NSCLC

King Hussein Cancer Center study

performance status impact

adrenal metastases

immune checkpoint inhibitor monotherapy

platinum-based chemotherapy

early palliative care

PD-L1 expression