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N. Prim



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    P1.11 - Poster Session 1 - NSCLC Novel Therapies (ID 208)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P1.11-047 - Management and outcome of Stage IV Non-small Cell Lung Cancer<br /> in a French department between 1998 and 2005 : the role of modern chemotherapy schemes and of the advent of targeted therapies (ID 3183)

      09:30 - 16:30  |  Author(s): N. Prim

      • Abstract

      Background
      Platin-based doublets with a third generation drug are the mainstay of the treatment of fit patients with stage IV non-small cell lung cancer (NSCLC). However, the results reached a plateau at the beginning of the XXIst century with a median survival time of 8-9 months in the randomized trials. Since 2002, personnalized treatment was developed with histology-guided chemotherapy and targeted therapies with a median survival time around 12 months and even 21 months in some patients harboring mutations.

      Methods
      To ascertain the improvement in survival of patients with advanced NSCLC since the advent of new chemotherapies and targeted therapies, we conducted a retrospective population based-study on a sample of 1047 patients diagnosed with stage IIIb (wet) and IV primary NSCLC in a French department (Bas-Rhin) from 1998 to 2005.

      Results
      Median age at diagnosis was 65.0 years [26-92]. Patients aged > 70 represented 32.4% of the patients. The proportion of women increased throughout the period with an initial sex-ratio of 3.8/1 in 1998-2001 to 2.5/1 in 2002-2005. Thirteen % of the patients were never smokers. The proportion of adenocarcinomas increased significantly throughout the period at the expense of squamous cell carcinoma subtype. Best supportive care was the sole treatment for only 11.75% of the patients. The use of chemotherapy increased from 74.2% to 87.1% of the patients (p = 0.0021), and type of chemotherapeutic agents have evolved with a significant increased use of carboplatin (while there was a decreased use of cisplatine) and of drugs of third-generation. Among them, vinorelbine was the most frequently used at the beginning of the period (38.8 % versus1.75% paclitaxel whereas during the two last years, the proportions were respectively 18.9% and 22.7%. Use of targeted therapies (gefitinib and erlotinib) began in 2002 with 15% of the patients receiving these therapies in 2004-2005 essentially as 2nd, third or 4th line therapy (only 4 patients as 1st line). Overall survival was 6.5 months [CI 95% 5.8; 7.2]. There was a significant increase from 5.3 months [CI 95% 4.4; 7.2] in 1998-1999 to 7.3 months [CI 95% 6.1;8.6] in 2004-2005. In multivariate analysis of survival, female gender, adenocarcinoma histological subtype were significant independent favorable prognostic factors. Regarding treatment variables, platin-based doublets with third generation drugs, use of targeted therapies were both independent favorable prognostic factors with respective RR of 0.66 (CI95%=0.53; 0.84), and 0.30 (CI95%=0.22; 0.40).

      Conclusion
      In this population-based study we found the same epidemiological trends recently seen in France (increase in women proportion and of adenocarcinoma histological subtype). Never-smokers were a non negligible fraction of the patients. The introduction of modern chemotherapy schemes and targeted therapies explain probably the slight improvement in survival observed between 1998-1999 and 2004-2005 as in multivariate analysis there were significant independent favorable prognostic factors whreas peiods were not..

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    P1.24 - Poster Session 1 - Clinical Care (ID 146)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P1.24-039 - Outcome of a series of 25 consecutive patients aged 84 and more with stage IV NSCLC : an invitation to systemic treatment (ID 2827)

      09:30 - 16:30  |  Author(s): N. Prim

      • Abstract

      Background
      Elderly patients and even more older elderly with stage IV NSCLC are often not optimally treated.

      Methods
      Not applicable

      Results
      Between april 1[st] 2010 and february 28th 2013, 25 patients ( aged 84 years or more were referred with a stage IV (11 M1a and 14 M1b) non-small cell lung cancer to our university hospital. There were 11 females and 14 males. There were 11 never-smokers. Median age was 87 years (range : 84-92). Histological subtypes were : 8 squamous cell carcinoma, 14 adenocarcinoma and 3 large cell carcinoma. Molecular analyses was performed in 17 cases among which 2 were impossible due to inappropriate biopsy specimen. EGFR- mutations were found in 4 female patients, 1 with exon 19 deletion and 3 with exon 21 point mutations. There were 3 K-RAS mutations and no ALK translocations. 6 patients received TKIs as first line treatment (5 gefitinib and 1 erlotinib). Two patients with no molecular analysis were treated with first-line TKI (both of them had PS 4, one died after 1.1 month, the other recovered very quickly and is still alive after 15.3 months). The other patients were treated with doublet carboplatine AUC 6 and weekly paclitaxel (90 mg/m², D1, 8, 15), with D1 = D29 (12 patients) or single agent therapy (paclitaxel (2), Gemcitabine (1), vinorelbine(1)). Three patients received only best supportive care (BSC). Doses of TKIs had to be lowered due to toxicity in 1 case. Median overall survival was 8.1 months with a one-year probability of survival of 46%. Survival of the 6 patients treated with first-line TKIs was 1.1, 3.1+, 6.43+, 14, 15.33+, 15.9+ months.

      Conclusion
      It must be noted that EGFR-mutations were more frequent compared to younger patients (at least 4/25) paralleling the high proportion of never-smokers (44%) and of female patients (44%). In this unselected consecutive series of older elderly patients, only 3 received BSC as sole treatment, while 4 were treated with single agent chemotherapy, 12 with a carboplatine-based doublet and 6 with TKIs as first line therapy, of which only 4 had proven EGF-R mutations. Survival was very similar to what is observed with younger counterparts and thus, nihilism is not appropriate in this category of patients.