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L. Kwok

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    P1.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 206)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P1.01-016 - Treatment Outcomes among Elderly Lung Cancer Patients > 65 Years following Clinical Use of EGFR Tyrosine Kinase Inhibitor  (ID 2552)

      09:30 - 17:00  |  Author(s): L. Kwok

      • Abstract

      Elderly patients (pts) with lung cancer pose significant challenges in cancer treatment because of concurrent comorbidities and age. We examined treatment patterns and outcomes in elderly pts with advanced lung cancer prior to and after introduction of epidermal growth factor receptor (EGFR) inhibitors into clinical use.

      Clinical data for pts > 65 yrs derived from two databases, cohort 1(1998-2003) and cohort 2(2004-current), were used. Demographics, clinical characteristics and treatment outcomes were compared between these 2 cohorts with stage III/IV lung cancer. Chi-square and Mann-Whitney-U tests were used to compare differences between cohorts. Overall survival (OS) from the time from diagnosis to death from any cause was estimated using Kaplan-Meier method and differences were defined using the logrank test. Pairwise comparisons were analyzed with Sidak’s adjustment applied to account for multiple testing. The Cox proportional hazards model was used to model the association between survival end-points and patient cohort, with the resulting hazard ratios assessed using the Wald test. The proportional hazards assumption was verified by fitting an alternative model with inclusion of a covariate-by-time interaction term and inspection of the p-value of the interaction term for categorical variables. A 2-sided p-value of <.05 was considered statistically significant.

      There were 397 pts (cohort 1) and 1584 pts (cohort 2) with complete data for analysis. The median age of diagnosis was not significantly different between the cohorts (72.5 yrs vs 72.8 yrs), p: 0.252. Median follow-up times were comparable. Cohort 1 had poorer ECOG at diagnosis, more males and a higher proportion of current smokers. For cohort 1, cytotoxic chemotherapy was standard of care and EGFR TKI use was minimal. In contrast, for cohort 2, 50% of pts received EGFR TKI monotherapy in 1[st] line, 30% of pts in 2[nd ]line and 33.3% of pts in 3[rd] line and beyond. There was a significant difference in OS between the both cohorts (p <.001), HR 0.75 in favor of cohort 2. Specifically women, good ECOG, never smoker status, and adenocarcinoma were associated with significantly reduced hazard of death.

      Routine EGFR TKI use in elderly > 65 yrs of age clinical setting has improved OS over the last decade. This benefit is reflected in the reduced hazards of death for specific patient subsets. Elderly pts where targeted therapies are indicated should not be deprived of therapy.