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Background: Invasive mucinous carcinoma (IMA) is a distinct histopathologic variant of adenocarcinomas of lung comprising about 2 -10%. A large proportion of IMAs carry KRAS mutations and only rarely EGFR mutations or ALK/ROS translocations, thus most cases are not amenable for targeted therapy at present. This study was conducted to elicit the unique clinico-pathological characteristics of IMA. Methods: Medical records of patients diagnosed with IMA by needle biopsy at Kidwai Cancer Institute, Bangalore from 2013 to 2018 were retrieved, clinical presentations and treatment outcomes were reviewed. Statistical analysis was performed using SPSS version 23.0. Results: 490 cases of needle biopsy of lung were done at our institute between 2013 and 2018. Nine cases (1.8%) were diagnosed as IMA. The median age was 59 years (range 49 -76 years). The male female ratio was 2:1. Six (66.7%) were current smokers with pack year greater than 20. The median symptom duration before diagnosis was 3 months. Three (33.3%) of the cases were initially misdiagnosed as pneumonia in view of CT findings of pneumonia-like multifocal consolidative appearance. Lung was the most common site of metastasis (77.8%). Serum CEA was elevated in six cases (66.7%). None of the cases had any mutations in EGFR gene or ALK and ROS1 translocations. All cases were treated with Pemetrexed-Carboplatin followed by Pemetrexed maintenance till progression. 5 (55.6%) patients had stable disease, 3 (33.3%) had partial response and 1 (11.1%) had progressive disease after three months of therapy. Median PFS was 12 months (Range 3 -18 months). Docetaxel was given as second line chemotherapy in all progressed patients. Best response noted was stable disease; seen in 4 (57.1%) cases. Median PFS with docetaxel was 6 months (range 3-8 months). Median overall survival 16 months (range 9 -27 months). Patients with progressive disease had serial rise in Serum CEA. Conclusions: IMA is rarely diagnosed on needle biopsies due to insufficient tissue for characterisation. They mimic pneumonia on imaging thus delaying diagnosis. EGFR mutations, ALK and ROS1 translocations are usually negative. Response to chemotherapy is modest. Serum CEA may be used as a tumor marker for response assessment.

Background:The incidence of lung cancer is rising in developing countries like India. Due to unaffordability among the low socioeconomic status (SES) patients, there is a significant delay in seeking appropriate medical treatment due to which a high proportion of patients present in an advanced/metastatic stage and the outcomes are poor.Objective:In this study, we studied the progression-free survival (PFS) and the pharmacoeconomic benefits with the cisplatin plus etoposide (EtoP) chemo regimen and compared it with the current generation chemo regimen.Materials and Methods:We performed a retrospective analysis of metastatic nonsmall cell lung cancer patients who received one or more cycles of platinum-based chemotherapy between 2011 and 2014.Results:Of the 304 patients, 56.6% of the patients were of the low SES. Of the low socioeconomic group patients, 67.45% and 31.4% received etoposide and paclitaxel platinum doublet combination regimen as first line, respectively. The mean PFS with the etoposide, paclitaxel, pemetrexed, and gemcitabine platinum-based doublet regimens were 9.35, 10, 10.76, and 9.83 months, respectively. Kaplan–Meier survival curve analysis showed a statistically significant initial survival with the first line EtoP cisplatin regimen for the initial 6 months of starting chemotherapy in comparison with the other regimens.Conclusions:This study showed a substantial pharmacoeconomic benefit with the cisplatin and etoposide chemo regimen in the lower socioeconomic group of patients. We believe that this is the first pharmacoeconomic study on metastatic non small cell lung treatment of great relevance to countries with limited resources.

median (IQR) lymph nodes harvested 25 (20-37), margins (close:free 1:10), extranodal extension 12%, LVSI 12%, PNI 16%. All resected patients completed adjuvant radiotherapy. Out of 14 patients deemed non-resectable, one underwent definitive CRT, and the rest were shifted to palliation. abstracts Annals of OncologyVolume 32 -Issue S5 -2021 S809