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J.H. Schiller



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    MO06 - NSCLC - Chemotherapy I (ID 108)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Medical Oncology
    • Presentations: 1
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      MO06.12 - Efficacy and safety of paclitaxel and carboplatin with bevacizumab for the first-line treatment of patients with nonsquamous non-small cell lung cancer (NSCLC): analyses based on age in the phase 3 PointBreak and E4599 trials (ID 2879)

      16:15 - 17:45  |  Author(s): J.H. Schiller

      • Abstract
      • Presentation
      • Slides

      Background
      A post hoc analysis of NSCLC patients (pts) aged ≥70 y in the pivotal E4599 trial found increased adverse events (AEs) and numerically decreased overall survival (OS) benefit associated with bevacizumab (BEV) compared with pts <70 y. We evaluated the efficacy and safety of BEV by age in pts in a pooled dataset from the E4599 and PointBreak (PB) trials.

      Methods
      Pts randomized to the PC (paclitaxel and carboplatin ) + BEV arms of E4599 and PB received P 200 mg/m[2], C AUC 6, and BEV 15 mg/kg q3w for 6 (E4599) or 4 (PB) cycles; Eligible pts received maintenance BEV alone q3w until disease progression or unacceptable toxicity. OS, progression-free survival (PFS), overall response rate (ORR), disease control rate (DCR), and safety were assessed in pts grouped according to age (<65 y, 65–74 y, 70–74 y, <75 y, and ≥75 y). Pt-level data from the PC + BEV arms of E4599 and PB were pooled and compared with data from pts in the PC-alone arm of E4599.

      Results
      PB and E4599 randomized 467 pts and 434 pts to PC + BEV, respectively, while 444 were randomized to receive PC alone on E4599. Baseline characteristics were balanced between age groups. OS and PFS hazard ratios (HRs) and increases in grade ≥3 AEs for the pooled pt cohort relative to E4599 PC-alone arm are shown (Table). Outcomes were similar in pts <70 y and ≥70 y, and data from the pooled population were similar to those seen in each individual trial (data not shown). ORR for pts <75 y was 39% with PC + BEV vs 26% with PC (P<.01). For pts ≥75 y, ORR was 33% vs 30% (P=.71). DCR in pts <75 y was 70% with PC + BEV vs 53% with PC (P<.01). For pts ≥75 y, DCR was 60% vs 67% (P=.37).

      Conclusion
      In a pooled exploratory analysis of pt data from E4599 and PB, the statistically significant benefit associated with the addition of BEV to PC appeared consistent across all age groups <75y, while pts ≥75 y receiving PC + BEV had no statistically significant survival benefit. Pts receiving PC + BEV had an increase in grade ≥3 AEs compared with pts receiving PC-alone in all age groups.

      PB + E4599 <65 y n=735 65–74 y n=453 70–74 y n=203 <75 y n=1188 ≥75 y n=157
      HR for OS 95% CI P 0.75 0.62–0.89 <.01 0.80 0.64–1.00 .05 0.68 0.48–0.96 .03 0.78 0.68–0.89 <.01 1.05 0.70–1.57 .83
      HR for PFS 95% CI P 0.71 0.60–0.85 <.01 0.62 0.49–0.78 <.01 0.68 0.48–0.96 .03 0.69 0.60–0.79 <.01 0.95 0.62–1.44 .80
      E4599 n=499 n=277 n=129 n=776 n=102
      Δ Grade ≥3 AEs,[a ]% P 13 <.01 21 <.01 23 <.01 15 <.01 25 <.01
      [a]Relative to PC-alone arm.

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    P3.24 - Poster Session 3 - Supportive Care (ID 160)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P3.24-044 - Explicit and implicit associations toward lung cancer (LC) relative to breast cancer (BC) (ID 2868)

      09:30 - 16:30  |  Author(s): J.H. Schiller

      • Abstract

      Background
      Emerging research suggests that LC may be associated with greater levels of stigma, shame and hopelessness compared to other cancers. This study measured explicit, conscious attitudes (EAs) and used the Implicit Association Test (IAT) to assess implicit, unconscious attitudes (IAs) and stereotypes (ISs) of LC relative to BC.

      Methods
      To assess EAs, participants (Ps), [people with cancer (n=243), caregivers (n=677), healthcare providers (HCPs, n=142), and the general public (n=864)] were asked to rate their agreement, on a six-point scale, with statements about how people with LC and BC “do feel” (descriptive attitudes) or “ought to feel” (normative attitudes) about their disease. Implicit attitudes were measured with three IATs that used LC or BC images with words representing good/bad; hope/despair; or suitable/shameful. Implicit stereotypes used images representing smoking cigarettes, drinking alcohol and eating unhealthy foods. An IAT D score indicated the strength of bias against LC relative to BC: >0.65 = strong bias; 0.35-0.65 = moderate bias; 0.15-0.35 = slight bias; -0.15 -+0.15 = no bias, and < -0.15 indicated bias against BC.

      Results
      EAs and IAs were substantially more negative towards LC. Most Ps provided more negative ratings for LC than BC for both descriptive (70%vs.8%) and normative statements (56% vs. 3%). Ps had strong negative IAs towards LC compared to BC (bad: 74% vs. 10%; despair: 75% vs. 9%; shame: 67% vs. 17%). In the stereotype IATs, Ps were far more likely to associate LC with smoking than with eating unhealthy foods or drinking alcohol. Conversely, Ps were far less likely to associate BC with smoking than with eating or drinking (smoking: 86% LC vs. 7% BC; eating: 86% LC vs. 7% BC; drinking: 67% LC vs. 18%BC). These trends were consistent across caregivers, patients, HCPs, and the public. EAs, IAs and ISs were uncorrelated.

      Caregivers Patients HCPs General Public
      EXPLICIT
      Negative Descriptive 75%, 7%, 18% 81%, 7%, 12% 88%, 5%, 7% 74%, 8%, 18%
      Negative Normative 59%, 3%, 38% 64%, 2%, 34% 65%, 3%, 32% 56%, 3%, 41%
      IMPLICIT ATTITUDES
      Bad D=0.43 73%, 12%, 15% D=0.33 72%, 13%, 15% D=0.33 63%, 17%, 20.0% D=0.44 74%, 9%, 17%
      Despair D=0.43 73%, 10%, 17% D=0.54 76%, 5%, 19% D=0.44 77%, 13%, 10% D=0.47 77%, 8%, 15%
      Shame D=0.32 65%, 18%, 17% D=0.52 82%, 9%, 9% D=0.41 72%, 11%, 17% D=0.35 66%, 17%, 17%
      IMPLICIT STEREOTYPES
      Smoking vs. Eating D=0.69 89%, 5%, 6% D=0.71 90%, 5%, 5% D=0.79 94%, 3%, 3% D=0.57 84%, 8%, 8%
      Smoking vs. Drinking D=0.34 65%, 18%, 17% D=0.17 54%, 31%, 15% D=0.54 81%, 5%, 14% D=0.34 69%, 17%, 14%
      Drinking vs. Eating D=0.10 40%,33%,27% D=0.22 54%, 23%, 23% D=0.21 59%, 29%, 12% D=0.16 50%, 27%, 23%
      Percentage order: LC bias%, BC bias%, No bias%. D=mean IAT score. All D scores significantly > 0 with ps<0.001

      Conclusion
      Ps had greater explicit and implicit negative bias against LC compared to BC.