High prevalence of targetable drivers but poor outcomes in lung adenocarcinoma: a real-world cohort from the French West Indies

Introduction Lung adenocarcinoma remains the most common subtype of non–small cell lung cancer (NSCLC), yet molecular epidemiology and real-world outcomes in Caribbean populations are poorly documented. Methods We conducted an 18-month, retrospective, population-based study including all consecutive patients diagnosed with lung adenocarcinoma in the French West Indies. Clinical, pathological, molecular, and survival data were collected at the University Hospital of Martinique, the sole referral center on the island. Results Of 159 patients, 58.5% presented with de novo metastatic disease and 14.4% had an unknown stage, more than half of whom died within 17 days, reflecting substantial diagnostic delays and early mortality. Actionable oncogenic drivers were identified in 62% of tumors, including EGFR (33%), KRAS (18%), BRAF (4%), ERBB2 exon 20 (4%), ALK (3%), ROS1 (3%), RET (1%), NRG1 (1%), and MET exon 14 skipping (4%). PD-L1 expression ≥1% was observed in 61% of patients, with a comparatively low proportion of PD-L1–high tumors, consistent with the high prevalence of EGFR mutations. Median overall survival was 19.3 months. Progression-free survival was longer with targeted therapies compared with immunotherapy ± chemotherapy, although overall survival remained similar. Discussion This study provides the first integrated clinical and molecular characterization of lung adenocarcinoma in the French West Indies and highlights the urgent need to improve early diagnosis, molecular testing access, and treatment initiation in underserved island populations.