A decade of Non-Small Cell Lung Cancer management: threats and opportunities in resource-limited setting

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Published Dec 27, 2025
https://doi.org/10.62438/tunismed.v103i10.6140
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Vol. 103 No. 10 (2025): Tunis Med Oct 2025

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Nesrine Mejri
Medical oncology department, Abderrahmen Mami Hospital, Ariana,Faculty of medicine University of Tunis El Manar, Tunis, Tunisia
Ahmed Anas Haouari
Medical oncology department, Abderrahmen Mami Hospital, Ariana,Faculty of medicine University of Tunis El Manar, Tunis, Tunisia
Myriam Saadi
Medical oncology department, Abderrahmen Mami Hospital, Ariana,Faculty of medicine University of Tunis El Manar, Tunis, Tunisia
Yosra Berrazaga
Medical oncology department, Abderrahmen Mami Hospital, Ariana,Faculty of medicine University of Tunis El Manar, Tunis, Tunisia
Seif Haddeoui
Medical oncology department, Abderrahmen Mami Hospital, Ariana,Faculty of medicine University of Tunis El Manar, Tunis, Tunisia
Lilia Ghorbel
Radiation therapy department, Abderrahmen Mami Hospital, Ariana, Faculty of medicine Tunis, University Tunis El Manar, Tunisa
Hamouda Boussen
Medical oncology unit, Clinique Toufik Hospital,Tunis, Tunisia
Haifa Rachdi
Medical oncology department, Abderrahmen Mami Hospital, Ariana,Faculty of medicine University of Tunis El Manar, Tunis, Tunisia
Yosr Hamdi
Laboratory of Biomedical Genomics and Oncogenetics, LR20IPT05, Institut Pasteur de Tunis,University Tunis El Manar, Tunisia

Abstract

Introduction: Non-small cell lung cancer (NSCLC) poses significant public health challenges in Tunisia.This study analyzes patient characteristics, management, and outcomes to identify improvement areas.


Methods: This retrospective multicenter study included 924 patients diagnosed with NSCLC between 2013 and 2022. The study reviewed clinical data, pathology reports, surgical records, radiation therapy summaries, and imaging findings. The study also examined trends in management features by dividing the study period into 2012-2017 vs 2018-2022.


Results: Median age was 60 years, with 78.7% being male, and the average tobacco consumption was 58 pack-years. Advanced-stage disease was highly prevalent, with 91% of patients presenting at stages III or IV. The median overall survival for the entire population was 32 months, varying significantly by disease stage: 52 months for stage I, 48 months for stage II, 22 months for stage III, and 14 months for stage IV. In advanced NSCLC, survival was notably higher among patients treated with targeted therapy (44 months) and immunotherapy (20 months) compared to chemotherapy alone (9 months). Over time, there was a significant increase in multidisciplinary discussions and biomarker testing rates; however, access to concurrent chemoradiation decreased. Despite some improvement, access to targeted therapy and immunotherapy remained limited. Among tested patients, a driver mutation was identified in 45.5%, but only 54% received targeted therapy. Furthermore, only 9.8% of advanced-stage patients received immunotherapy.


Conclusion: This study serves as a baseline for future studies and highlights critical gaps in NSCLC care in Tunisia, emphasizing the need for strategic directions to enhance outcomes.

Keywords:

non-small cell lung cancer, survival, management, gaps

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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