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V. Avrillon
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P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.01-058 - Factors Predicting Long Duration of Pemetrexed Maintenance Therapy: A Retrospective Cohort of 65 Patients (ID 2111)
09:30 - 17:00 | Author(s): V. Avrillon
- Abstract
Background:
BACKGROUND: The Paramount trial demonstrated a significant survival benefit with pemetrexed continuation maintenance therapy for non-squamous NSCLC. This retrospective work aims to study predictive factors for a long duration of maintenance therapy and its toxicities.
Methods:
METHOD: All patients who received pemetrexed maintenance between 1st January 2009 and 1st July 2013 in Centre Léon Bérard (France) were included. Patients were classified in two groups: “long maintenance” if they received ≥ 5 cycles of maintenance with pemetrexed and “short maintenance” if they received ≤ 4 cycles. We retrospectively collected data about patients (age, gender, smoking status, PS), histological subtype, number of metastatic sites, number of induction and maintenance cycles, response to induction chemotherapy, bevacizumab use, reason for discontinuation, and toxicities. Proportions of patients or disease characteristics in each group were compared with univariate test (Fisher exact and Wilcoxon).
Results:
RESULTS: 65 patients were included, 33 in “short maintenance” group and 32 in “long maintenance” group, with 60% male and a mean age of 61.13 (±7,78). 55% of patients had ≥ 2 metastatic sites with PS 0, 1 or 2 in 21%, 67%, and 13% out of patients, respectively. Induction cycles were initiated with cisplatin in 71% and carboplatin in 29% of patients; median number of induction cycles was 4 [3-6]. 39% of patients achieved partial response to induction chemotherapy and 61% stable disease. Median number of maintenance cycles was 4 [1-28]. 19 patients (29%) received bevacizumab in combination to pemetrexed during induction and maintenance therapy. Maintenance discontinuation was due to progressive disease in 61%, toxicity in 19% and local treatment in 16% of patients, respectively. Significant predictive factors of a long duration of maintenance therapy were female gender (27% vs 53%; p=0.044) and ≥ 2 metastatic sites (42% vs 70%; p=0,046). Age, smoking status, histological subtype, response to induction therapy, bevacizumab use, and PS were not significantly related to maintenance duration. Grade 3-5 adverse events occurred in 20 patients (31%) including 5 treatment-related deaths (8%) (including 4 infectious-related deaths). There was a similar rate of grade 3-5 toxicities in both groups. Toxicities were mainly infectious (n= 13; 65%) including 4 febrile neutropenia. Predictive factors of grade 3-5 toxicities were age > 70 years (35% vs 9%; p=0.026) and carboplatin use (50% vs 20%; p=0,020). At the end of the study, maintenance therapy was ongoing in 3 patients. Among the 62 other patients, 81% received subsequent systemic therapy with a similar duration of treatment between “short” and “long” maintenance groups.
Conclusion:
CONCLUSION: Univariate analysis identified female gender and ≥2 metastatic sites as only predictive factors for a long duration of pemetrexed maintenance therapy. Patients with single metastasis frequently stopped maintenance treatment for administration of local therapy. Predictive factors for severe toxicities were age > 70 years and carboplatin use whereas addition of bevacizumab to pemetrexed did not result in an increase of toxicity.
