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P. Wheatley-Price



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    MO13 - SCLC I (ID 118)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Medical Oncology
    • Presentations: 1
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      MO13.02 - Age as a prognostic factor in small cell lung cancer. A pooled analysis of randomized clinical trials from the Manchester lung cancer group (MLCG) and the UK Medical Research Council Clinical Trials Unit (MRC CTU). (ID 2270)

      10:30 - 12:00  |  Author(s): P. Wheatley-Price

      • Abstract
      • Presentation
      • Slides

      Background
      About 40% of all cases of small cell lung cancer (SCLC) occur in the over 70 year age group (70+), and 10% in patients aged over 80 years. A SEER database reports decreasing SCLC 5-year survival with age (7.1%, 3.9% and 2.2% in the <70, 70-79 and 80+ age groups, respectively). However age has been inconsistently reported as a prognostic factor in SCLC trials. Recently a series of randomized trials of chemotherapy (CT) in SCLC were pooled to analyze the prognostic impact of patient sex (Wheatley-Price et al, Annals of Oncology 2009). We used the same dataset to investigate the impact of age.

      Methods
      Five randomized phase II and III CT trials, performed by the MLCG and MRC CTU between 1993 and 2005, were pooled for analysis (one study from the previous analysis was excluded as it did not contain elderly patients). One trial investigated a dose-dense approach and 4 trials compared CT regimens. The primary endpoints were overall survival (OS) in limited stage (LS) and extensive stage (ES) and the rates of haematological and non-haematological toxicity.

      Results
      In total 1439 patients were included, of whom 45% were female and 36% had ES disease. The median age was 63 years (range 30-88), and 343 (24%) were 70+, and only 33 (2%) were 80+. Anthracycline-based CT was given in 61%, versus platinum-based CT in 38% of patients. More patients in the younger group had a good performance status (ECOG 0-1, Karnofsky 80-100); 65% versus 39% (p=0.0007). Baseline hyponatremia was present in 35% and did not differ by age group. Overall, median OS was significantly longer in younger patients in univariate analysis (9.3 months versus 7.4 months; HR 0.79, 95% CI 0.66-0.95, p=0.01). By disease stage, median OS in LS patients was significantly longer in younger patients (HR 0.88, 95% CI 0.79-0.99, p=0.04), and a similar effect was observed in ES (HR 0.75, 95% CI 0.55-1.01, p=0.06). However in multivariate analysis (age, stage, sex, hyponatremia, anemia), factors significantly associated with longer survival were LS, female sex, good PS and absence of hyponatremia, but younger age was no longer prognostic (HR 0.96, 95% CI 0.86-1.08, p=0.52). The elderly were more likely to experience grade 3 or 4 leucopenia (52% versus 40%, p=0.0035), neutropenia (36% versus 31%, p=0.045) and thrombocytopenia (34% versus 22%, p=0.0003), but less likely to experience grade 3 or 4 emesis (8% versus 14%, p=0.022) or mucositis (5% versus 11%, p=0.021). There were no differences in infection rates or blood transfusion rates, although the elderly required more platelet transfusions (p<0.0001). The dose intensity (total number of CT cycles delivered divided by the planned number of cycles) was higher in the younger group (p<0.0001).

      Conclusion
      In a large pooled analysis of CT trials in SCLC, age was not a prognostic factor for survival. However the elderly experienced higher rates of grade 3 and 4 hematological toxicity. Further analysis is ongoing.

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    P1.10 - Poster Session 1 - Chemotherapy (ID 204)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P1.10-042 - Chemotherapy in advanced non-small cell lung cancer patients previously treated with adjuvant chemotherapy (ID 2349)

      09:30 - 16:30  |  Author(s): P. Wheatley-Price

      • Abstract

      Background
      Adjuvant chemotherapy (CT) improves survival in patients (pts) with completely resected early stage NSCLC. Adjuvant cisplatin/vinorelbine (CV) is considered a standard of care in this population. However many pts relapse and require palliative CT, which may involve platinum doublet CT again. We investigated treatment choices on relapse after prior adjuvant CT, specifically in pts receiving palliative platinum doublet CT, and its impact on response rate (RR) and overall survival (OS).

      Methods
      With ethics approval, we performed a retrospective chart review of all pts with resected NSCLC who received adjuvant CT from January 2002 until December 2008 at our institution. Baseline pt demographics and cancer stage were recorded, along with treatment decisions upon relapse. The primary outcome was the RR to first-line palliative systemic therapy (ST).

      Results
      We identified 176 pts who received adjuvant platinum doublet CT (82% received CV). Patient characteristics were: median age 63 years (range 25-82); 55% female: median follow up 4.2 years: the primary surgical procedures were lobectomy (79%) or pneumonectomy (16%). The pathologic stage at surgery was 1A (2%), 1B (30%), 2A (7%), 2B (40%) and 3A (15%). In total 85 pts relapsed (48%), with a median time to relapse of 18.5 (95%CI 15-21.3) months. The variable most strongly associated with a shorter time to relapse was nodal stage (p=0.03); increasing T stage also demonstrated a trend towards shorter time to relapse (p=0.09). Of the 85 relapsed pts, 43 received palliative CT, and 42 received best supportive care (BSC) alone. Of the 43 pts treated, 25 (58%) were re-challenged with platinum doublet CT, with a RR of 28%, versus 17% (p=0.47) in 18 pts receiving other ST (most commonly docetaxel [n=7, 39%] or erlotinib [n=4, 22%). There was a trend towards increased clinical benefit rate (CR+PR+SD) in patients who were treated with a platinum doublet (67% versus 41% p=0.12). For all pts the median OS after relapse was 11.6 months. In pts receiving any CT (n=43), median OS was 15.3 months, compared to 7.8 months in those receiving BSC alone. Pts in the platinum-treated group had a longer survival after relapse than those pts treated with non-platinum regiments (18.4 versus 9.7 months, p=0.041). See Figure 1.Figure 1

      Conclusion
      In pts previously treated with adjuvant CT, re-treatment with platinum doublet CT upon relapse is feasible and associated with numerically higher response rates and significantly longer survival than those receiving other first-line ST.

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    P1.15 - Poster Session 1 - Thymoma (ID 189)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Thymoma & Other Thoracic Malignancies
    • Presentations: 1
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      P1.15-006 - Thymic malignancies. A single institution series from 2000-2012 (ID 2287)

      09:30 - 16:30  |  Author(s): P. Wheatley-Price

      • Abstract

      Background
      Thymoma and thymic carcinoma are rare malignancies, despite being amongst the most common tumours of the anterior mediastinum. The incidence of thymoma in the United States is approximately 0.15 per 100,000 person years. Thymoma research has proved challenging, and as such the International Thymic Malignancy Interest Group (ITMIG) has created an international database in an effort to promote the advancement of clinical and basic science research in thymic malignancies. We performed a single institution retrospective chart review to submit to ITMIG, collecting additional data regarding systemic therapy regimens.

      Methods
      With ethics approval, we performed a retrospective chart review of all patients seen at our institution between January 2000 and December 2012 with a diagnosis of thymic neoplasm. Data collected included baseline patient demographics, histology (WHO), staging (Masaoka), the presence or absence of associated paraneoplastic syndromes such as myasthenia gravis (MG), treatment decisions and survival. All lines and indications of systemic therapy were recorded.. The primary analysis is descriptive.

      Results
      In total 76 patients were included; 35 female (46%); median age at diagnosis 60 years (range 25-89) and 71 (93%) had a good performance status (ECOG 0-1). MG was present in 16 (21%). The WHO histological classification was: A (11, 15%), AB (23, 30%), B1 (12, 16%), B2 (10, 13%), B3 (13, 17%), C (5, 7%), NETT (1, 1%), and unclassified (1, 1%). Definitive surgery occurred in 64 cases (84%), with an R0 resection in 53 patients. For those who had surgery, 11 also received chemotherapy either as induction (6), adjuvant (4) or both (1); 27 received radiotherapy either as induction (2) or adjuvant therapy (25). Twelve patients (16%) were not treated surgically, and three patients received no therapy at all. In total only 14 patients (18%) received systemic therapy in any setting. Where evaluable, the first-line RECIST response rate was 55%, but no patients had progressive disease (Figure). Common first-line regimens were platinum/etoposide (8), carboplatin/paclitaxel (3) and CAP (cyclophosphamide, adriamycin, cisplatin, n=2). Only 3 patients received further chemotherapy (1 patient received 2 further lines; 2 patients received 3 more lines). The median follow up for all patients was 45 months, and 59 (78%) remain alive. Of the 5 thymic carcinoma patients, 4 have died (median survival 10 months).

      Conclusion
      While few patients received systemic therapy for thymic malignancies, it remains a chemosensitive disease, but surgical resection is the mainstay of treatment.Figure 1