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G. Hillerdal
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MO24 - NSCLC - Chemotherapy III (ID 110)
- Event: WCLC 2013
- Type: Mini Oral Abstract Session
- Track: Medical Oncology
- Presentations: 2
- Moderators:R. Feld, S. Peters
- Coordinates: 10/30/2013, 10:30 - 12:00, Parkside Ballroom A, Level 1
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MO24.01 - Treatment of elderly (70 years or older) with lung cancer. A four-year material in clinical practice from Karolinska University Hospital - Sweden. (ID 2562)
10:30 - 12:00 | Author(s): G. Hillerdal
- Abstract
- Presentation
Background
Sixty percent of all neoplasms and two-thirds of all deaths due to cancer occur in persons older than 65 years. More than 50% of patients with lung cancer are older than 65 years and 30% older than 70 years. With more persons surviving to older age treatment of the elderly with lung cancer has become an important issue.Methods
All patients 70 years or older with non small cell lung cancer (NSCLC) seen at the Department of Respiratory Medicine and Allergy, Karolinska Hospital from 2003 to 2006 were retrospective reviewed. In all 659 patients were analyzed.Results
The mean age was 78 years, 55.5 (%) were men. 93,2% of the males and 82.1% of the females were smokers or former smokers. There was a significant differences between smoking habbits among the genderas (P<0.0001). 77.2 (%) had PS 0-2. 38.4% adenocarcinoma, 9.8% with small cell lung cancer, 20.6% squamous cell carcinoma, 15.6% had clinical lung cancer and the others broncheoalveolar cell carcinoma or low differentiated carcinoma were 15.3%. 10.7% underwent radical surgery, 24% received chemotherapy only, 17.8% radiotherapy against the tumour (there of stereotactic 4.4%), and 3.7% concomitant chemo-radiotherapy. 7.4% received radiotherapy against metastases, and 32.1% had no therapy. Only 10% were given second-line chemotherapy. Median survival for patients 70-75, 76-80 and >80 years was 231, 250 resp 213. Median survival for patients with PS=0 was 810 days, those with PS=3 only 109 days. Median survival was 610 days for patients given second line chemotherapy. Survival among those who received only first line chemotherapy was 285 days.Conclusion
Significant survival among patients given second line chemotherapy (p<0.003). Significant survival among patients between 70-80 versus > 80 years old (P<0.001). Treatment of elderly patients with lung cancer is feasible if they have a good PS and seems to result in prolonged survival.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MO24.03 - Treatment of elderly patients ( > 70 years ) with non-small cell lung cancer given chemotherapy. A four-year material in clinical practice from Karolinska University Hospital - Sweden. (ID 3257)
10:30 - 12:00 | Author(s): G. Hillerdal
- Abstract
- Presentation
Background
Sixty percent of all neoplasms and two-thirds of all deaths due to cancer occur in persons older than 65 years. More than 50% of patients with lung cancer are older than 65 years and 30% older than 70 years. With more persons surviving to older age treatment of the elderly with lung cancer has become an important issue.Methods
All patients 70 years or older with non small cell lung cancer (NSCLC) given chemotherapy at the Department of Respiratory Medicine and Allergy, Karolinska Hospital from 2003 to 2006 were retrospective reviewed. In all 149 patients were analyzed.Results
The mean age was 75,5 years and median 74 years. 54.4 % were male. 96,3% of the males and 88.2% of the females were smokers or former smokers. There was a significant differences between smoking habitts among the genderas (P<0.05). 16.1% , 50.3% and 27.5% had PS 0 resp 1 resp 2. 57.7% and 30.9% with stage IV resp III . 32.9% adenocarcinoma, 24.8% squamous cell carcinoma, and the others broncheoalveolar cell carcinoma or low differentiated carcinoma were 24.2%. 18.1% of the patients had no histopathological diagnosis – clinical diagnosis. Almost all the patients were given carboplatin/gemcitabin as first line chemotherapy regardless of histology. Four cycles was given to almost all the patients. Only 27.5% were given second-line chemotherapy. Median overall survival was 285 days. Longer overall survival among 70-80 vs > 80 years old patients.Conclusion
Significant survival among patients between 70-80 versus > 80 years old.. Treatment of elderly patients with lung cancer is feasible if they have a good PS and seems to result in prolonged survival.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P2.10 - Poster Session 2 - Chemotherapy (ID 207)
- Event: WCLC 2013
- Type: Poster Session
- Track: Medical Oncology
- Presentations: 2
- Moderators:
- Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P2.10-004 - Addition of bevacuzimab (BEV) to pemetrexed (PEM) plus cisplatin (CIS) induction and PEM maintenance therapy in 1st line setting for treatment of advanced nonsquamous non small cell lung cancer (NS-NSCLC) - final results and safety update from a phase 2 study (ID 234)
09:30 - 16:30 | Author(s): G. Hillerdal
- Abstract
Background
1st line PEM+CIS induction chemotherapy (CT) followed by PEM maintenance and 1st line BEV-based CT followed by BEV maintenance offer clinical benefit (progression-free and overall survival; PFS and OS) in NS-NSCLC. This study explored efficacy and safety of 1st line induction PEM+CIS+BEV followed by maintenance PEM+BEV.Methods
Patients with advanced NS-NSCLC and ECOG performance status (PS) 0-1 were planned to receive 4 cycles PEM 500 mg/m[2], CIS 75 mg/m[2], BEV 7.5 mg/kg, given every 3 weeks. In the absence of progressive disease (PD) and in the case of ECOG PS 0-1, patients could continue on PEM+BEV until PD or unacceptable toxicity. All patients received vitamin supplementation as per PEM label. Primary endpoint was PFS; secondary endpoints included OS, response rate and toxicity. PFS without Grade (G)4 toxicity was additionally assessed.Results
109 patients were enrolled in 5 countries. Characteristics: median age 61 years, males/females 59/41%, ECOG PS 0/1 54/46%, stage IIIB/IV 9/91%, adenocarcinoma 91%. 72 patients (66%) received maintenance CT. Overall median (maximum) number of cycles were 8(34) for PEM+BEV and 4(4) for CIS. Median PFS was 6.9 months (90% CI 5.7, 8.3). Table 1 summarizes efficacy data; Table 2 presents G1-4 adverse event (AE) data, including AEs of special interest regarding BEV. 2 patients died from study-drug related toxicity (GI hemorrhage, pneumonia aspiration; during induction CT). Figure 1 Figure 2Conclusion
In this study of PEM+CIS+BEV induction CT followed by PEM+BEV maintenance, median PFS was 6.9 months. The addition of BEV to PEM-CIS induction and PEM maintenance was associated with acceptable and expected toxicities. Main G3/4 toxicities included neutropenia and fatigue, hypertension was less common. -
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P2.10-042 - Lung cancer among Swedish and imigrants. Incidens, histopathology, treatment and survival. (ID 2584)
09:30 - 16:30 | Author(s): G. Hillerdal
- Abstract
Background
Lung cancer represents the leading cause of cancer-related death world wide. Several studies have shown that the risk of developing lung cancer is associated with socioeconomic status. Recently a Swedish study showed that socioeconomically disadvantaged groups with NSCLC receive less intensive care. Low education remained an independent predictor of poor survival only in women with early stage disease. Foreign-born people constitute 12.5% of the Swedish population in Sweden.Methods
A retrospective analysis of all patients with lung cancer at the Department of Respiratory Medicine and Allergy, Karolinska University Hospital - Solna during 030101—061231. In all, 1353 cases of lung cancer were diagnosed in which 157 (11.6%) were immigrants. The mean age in Swedish patients was 69, median 70 and range 38-96 years. The figures for the immigrants was 65, 66 respectively 38-90 years.91,3% of the Swedish and 92,3% of the immigrant patients were either smoker or former smoker. There was no significant differences between the groups.Results
In 105 (8,8%) Swedish and 7 (4,5%) of the immigrants the diagnosis was clinical Adenocarcinoma was the most common subtype found in both Swedish and immigrant patients 44,7% respectively 40,1%, squamous cell carcinoma 17,5% resp 21,7% and small cell lung cancer 12,2% respectively 14% . No significance differences between the groups.19,1% of the Swedish and 14% of the immigrants were diagnosed as stage I, 2,4% resp 4,4% as stage II, 7,9% resp 7% as stage IIIa and 70,4% resp 74,5% as stage IIIB/IV. Nearly 86% of the Swedish and 84,1% of the immigrants had PS 0-2 and 14,3% resp 15,9% had PS 3-4. Chemotherapy given to 387(32,4%) of the Swedish and 58(36,9%) of the immigrants, concomitant chemo-radiotherapy to 90(7,5%) resp 16(10,2%), radiotherapy against the tumor 8,4% resp 8,3%, SBRT to 2,7% resp 1,3%. Surgery were performed among 9,1% of the Swedish and 10,8% of the immigrants, 5,9% resp 4,5% given adjuvant chemotherapy. Approximately 20% of the Swedish and 15,9% of the immigrants given no therapy at all. There was no significant differences in treatment between the two groups p<0.551.The median survival time for the Swedish patients was 245 days and for other nationalities it was 269 days with no statistical significant difference. For Swedish female patients the median survival time was 273 days and for females from other nationalities it was 329 days with no significant difference.No significant differences in survival and staging between the swedish and the imigrants. There was no significant difference in survival between Swedish and non-Swedish patients within performance status groups.Conclusion
In this study, we used cohort of patients with lung cancer (except carcinoid), with a focus on ethnicity, to determine whether racial/ethnic disparities exist in overall survival. Another objective of our analysis was to determine whether any differences in survival could be attributed to disease-associated variables. To our best knowledge no previous study has investigated the incidens of lung cancer in immigrants in Sweden. This study showed no significant difference in survival between immigrants and Swedish patients with lung cancer.
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P2.19 - Poster Session 2 - Imaging (ID 180)
- Event: WCLC 2013
- Type: Poster Session
- Track: Imaging, Staging & Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P2.19-002 - Pulmonary tularemia: a rare disease which can be mistaken for lung cancer (ID 912)
09:30 - 16:30 | Author(s): G. Hillerdal
- Abstract
Background
Acute infections can sometimes radiologically be suspected to be lung cancer. Only rarely are, however, the mediastinal lymph nodes enlarged. Tularemia is a disease in rodents caused by the bacterium Fransiscella tularensis but it can also infect humans if infective material is inhaled, and typically lung infiltrates and PET-positive nodes persist for a few months. We have not found any good description of this entity in the literature and therefore we describe three such cases.Methods
During two years, three patients were referred for suspected lung cancer. One was a farmer and two who had cleaned out their summer house after the winter invasion of mice. PET investigation with [18]F-fluorodeoxyglycose (FDG) was strongly positive both in the "tumor" and in the enlarged mediastinal lymph nodes. Bronchoscopy showed inflammatory cells only.Results
There was a spontaneous regression of the lesions during the investigations and serology proved the etiology.Conclusion
Like the classical plague, there are two variants of tularemia: peripheral wounds or insect bites can cause the ulceroglandular form, with an ulceration and enlarged local lymph nodes nodes which can suppurate, and inhalation of infectious material (for example, mouse excrements) can cause a localized pulmonary infiltrate and enlarged mediastinal lymph nodes which will readily be mistaken for lung cancer. Diagnosis is by serology; treatment is mainly by tetracyclines, but by the time investigation is started the disease is usually already healing spontaneously. History is very important: has the patient has any contact with mice or other rodents or their droppings?
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P2.20 - Poster Session 2 - Early Detection and Screening (ID 173)
- Event: WCLC 2013
- Type: Poster Session
- Track: Imaging, Staging & Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P2.20-002 - Investigating suspected lung cancer: fast track in Stockholm (ID 356)
09:30 - 16:30 | Author(s): G. Hillerdal
- Abstract
Background
Doctors´ delays can sometimes be very large in investigations of suspected lung cancer. The main problem seems to be the many steps involved, with delays at all levels. In order to speed up the process within the available limited resources we have in Stockholm constructed a “fast track”.Methods
The majority of suspected lung cancers in the Northern Stockholm area are referred to the Lung Clinic in Solna from GP:s and other clinics. Patients who from this information were judged to suffer from potentially curable lung cancer were admitted to the fast track, where the first visit should occur within a week and the investigations (broncoscopy, PET-CT, spirometry etc) was planned by a special nurse within the next week.Results
From December, 2009, to march, 2013, 219 patients, 109 women and 110 men, have been investigated. The mean age was 67 years (55-82). The mean time from referral to first visit was 6,1 days and 77% were seen within one week. From referral to treatment decision, the mean was 17.8 days. There were 149 primary lung cancers, thereof 105 adenocarcinomas, 18 squamous, and 13 small cell cancers. Stage I-II were 74, III 35, and IV 41. Surgery was performed on 65 patients, 17 of whom the diagnosis was made at surgery. Potentially curative radiotherapy or chemoradiotherapy was given in 44 patients. Three lymphomas, one sarcoma, and 6 metastases from earlier unknown cancers were also seen. Thus, 109 (73%) received a potentially curative therapy. Benign lesions were seen in 56 persons (26%), mostly hamartomas or infections but only one active TB. Two granulomas were operated. PET-CT also disclosed 6 concurrent and earlier unknown cancers in other organs among the cancer patients and in two with a benign diagnosis. During the period, approximately 900 primary lung cancers were diagnosed at the clinic, so about 17% went in the fast track, which was limited by available resources.Conclusion
A fast track is feasible and possible even without added resources. PET-CT gives very valuable information on spread of disease but also other cancers.
