Lung Cancer and Risk Factors in Lebanon: Epidemiology, Temporal Trends, and Comparison to Countries From Different Regions in the World

Effects of Lack of Access to Immunotherapy Medications on Survival of Lung Cancer Patients

AIMS

Lung cancer is the leading cause of cancer-related deaths globally. With the great advancements in the treatment, the accessibility and availability of expensive treatments such as immunotherapy can be affected by economic factors. This research aims to examine how the economic crisis in Lebanon influenced the progression-free survival (PFS) of individuals with metastatic non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

A retrospective study was conducted on 84 patients with stage IV NSCLC treated at a tertiary care center in Lebanon. Patients were divided into two groups based on their treatment period: a control group (January 2019- December 2020) and a crisis group (October 2021 - December 2022). Data on patient demographics, treatment regimens, dose densities, and PFS were collected and analysed.

RESULTS

The control group had a median PFS of 11.11 months, compared to 8.40 months for the crisis group. More patients in the control had access to immunotherapy (46.9% versus 31.4%, p = 0.47). Importantly, patients who received less than 50% of the standard immunotherapy dose did not have a shorter PFS compared to those who received the full dose. Statistical analysis did not reveal a significant correlation between immunotherapy dose density and PFS (p = 0.107).

CONCLUSION

Access to immunotherapy medications in first line therapy of metastatic NSCLC has a clear impact on PFS. However, patients receiving lower doses of immune checkpoint inhibitors (ICIs) demonstrated a similar PFS compared to those receiving full doses, which challenges conventional dosing strategies and suggests that effective cancer treatment can be achieved with lower dosing regimens. These findings open the door for further investigation to explore the relationship between immunotherapy dose and PFS.

Beyond Body Size: Adiponectin as a Key Player in Obesity-Driven Cancers

Obesity, a complex and multifactorial disease influenced by genetic, environmental, and psychological factors, has reached epidemic proportions globally, posing a significant health challenge. In addition to its established association with cardiovascular disease and type II diabetes, obesity has been implicated as a risk factor for various cancers. However, the precise biological mechanisms linking obesity and cancer remain largely understood. Adipose tissue, an active endocrine organ, produces numerous hormones and bioactive molecules known as adipokines, which play a crucial role in metabolism, immune responses, and systemic inflammation. Notably, adiponectin (APN), the principal adipocyte secretory protein, exhibits reduced expression levels in obesity. In this scoping review, we explore and discuss the role of APN in influencing cancer in common malignancies, including lung, breast, colorectal, prostate, gastric, and endometrial cancers. Our review aims to emphasize the critical significance of investigating this field, as it holds great potential for the development of innovative treatment strategies that specifically target obesity-related malignancies. Furthermore, the implementation of more rigorous and comprehensive prevention and treatment policies for obesity is imperative in order to effectively mitigate the risk of associated diseases, such as cancer.

Efficacy of lung cancer screening at the American University of Beirut Medical Center

Introduction

In Lebanon, a dedicated screening program for lung cancer is absent. Screening is largely based on the recommendation of an informed physician or the initiative of a patient. To better understand the situation, it is important to look at the available data on patients currently being screened for lung cancer in this country. Our aim in this study is to review the data and compare it with that in the literature as well as to assess the efficacy of the screening process followed.

Methods

Our study accessed the electronic medical records of patients at the American University of Beirut Medical Center (AUBMC), a tertiary care center in Lebanon. We collected information on patients who underwent screening low-dose computed tomography (LDCT) scan between June 2019 and June 2021 inclusive. Records of all patients who underwent a non-contrast computed tomography (CT) scan at AUBMC during this period were collected and analyzed.

Results

On average, our population had a 52.6 pack-year smoking history. Moreover, 47% of our population had an accurate pack-year reported, while 12% did not have enough information to even estimate their pack-year history. When looking at the accurate and estimated data, 5% of our population did not even meet the ≥20 pack-year smoking history. Eight patients had positive findings on the screening LDCT, which we defined as suspicious findings that require further workup (e.g., PET/CT or biopsy) or other significant incidental findings.

Conclusion

A well-organized program for lung cancer screening in Lebanon is absent. Screening largely depends on the initiative of the physician or the patient. We were able to uncover multiple flaws in the screening method used, including poor documentation and follow-up. Although the screening method adopted retained some benefits in terms of detecting early malignancy, it lacked proper organization and was not ideal. A better, systematized screening program is needed to have optimal outcomes.