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T. Ahmad
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P1.03 - Poster Session with Presenters Present (ID 455)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.03-010 - Characteristics of Lung Cancer Patients Diagnosed Following Emergency Admission (ID 5091)
14:30 - 15:45 | Author(s): T. Ahmad
- Abstract
Background:
The proportion of patients with cancers diagnosed via the emergency route and their demographic characteristics vary according to tumour type[1]. Patients with lung cancers diagnosed as emergency presentations suffer worse outcomes[2]. The aim of this observational study was to determine the characteristics of a sample of patients with new lung cancers presenting through the emergency route.
Methods:
Clinical and demographic patient data were extracted from the London Cancer Registry. Data relating to emergency presentations of lung cancer were collected prospectively between January and August 2013 from nine acute trusts across northeast and central London and west Essex. Clinical and demographic characteristics were collated. The total number of emergency presentations were compared to the total numbers of lung cancers diagnosed within the same region over the corresponding time frame from the National Lung Cancer Audit data (NLCA).
Results:
Figure 1From the NLCA, there were an estimated 964 lung cancers recorded within the London cancer region during the study period. Of these, 310 (32%) lung cancers were recorded in the London Cancer registry as having presented via the emergency route. The median age of these patients was 73. The majority of patients were white and from areas of increased social deprivation. The proportion of patients presenting with stage IV disease was 67%, while 58% had a performance status of 0-2. The most common presenting symptoms were respiratory. 95% of patients were treated with palliative rather than curative intent.
Conclusion:
Approximately one third of new lung cancers within London Cancer are diagnosed following emergency admission. The next phase of work includes incorporating results from the London Cancer Alliance to provide pan-London data and to develop tools in primary care to identify these patients prior to emergency admission.
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P3.02b - Poster Session with Presenters Present (ID 494)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.02b-046 - Afatinib Benefits Patients with Confirmed/Suspected EGFR Mutant NSCLC, Unsuitable for Chemotherapy (TIMELY Phase II Trial) (ID 4195)
14:30 - 15:45 | Author(s): T. Ahmad
- Abstract
Background:
Afatinib is licensed for EGFR-mutant NSCLC without prior TKI therapy, but its efficacy and toxicity in patients unsuitable for platinum-doublet chemotherapy is unknown. One previous study suggested that TKIs could benefit medically unfit EGFR-mutant East Asian patients. We conducted the first such study in a Western population.
Methods:
Single arm phase-II trial. Eligible patients with histologically confirmed NSCLC, comorbidities precluding chemotherapy, with either: (i) confirmed EGFR-mutation and PS 0-3, or (ii) suspected EGFR-mutation (no suitable tissue for genotyping or failed genotyping), but never/former-light smoker, adenocarcinoma and PS 0-2. Patients received oral afatinib (20-40mg daily) until disease progression/toxicity. CT scans performed 4 weeks after starting treatment then every 8 weeks in first year until progression, thereafter every 12 weeks. Primary endpoint was 6-month RECIST-defined progression-free-survival (target 30%).
Results:
39 patients were recruited across 14 UK centres (March 2013-August 2015). Median age 72 years (range 36-90); 30 females, 9 males; 20 confirmed and 19 suspected EGFR-mutant; 8 former and 11 never smokers (among suspected EGFR-positives); 1,1,7,30 in each stage IA,IIIA,IIIB,IV; and 27 PS 0-1, 12 PS 2-3. As of July 2016, 7 patients were still taking afatinib (median time on drug 11 months, range 10-16), and 11 stopped for toxicity. 23/39 patients had at least one grade ≥3 afatinib-related toxicity (all gd3, except two with gd4 [sepsis and hypokalemia], one fatal pneumonitis), mainly: n=13 diarrhoea; n=4 vomiting; n=3 dehydration; n=3 mouth ulcer, all expected for afatinib, and unsurprising in this unfit group. The table shows efficacy. 6-month PFS rate (58%) far exceeded the 30% target; similarly for patients with confirmed (74%) or suspected (41%) EGFR-mutation.Efficacy (26 PFS events, 21 deaths)
Rate (95%CI) at month Alive & progression-free Overall-survival All patients (n=39) 6 58% (43-74) 74% (60-88) 12 34% (18-50) 64% (48-80) Median, months (95%CI) 7.9 (4.6-10.2) 15.5 (10.9-25.1) Confirmed EGFR mutant (n=20) 6 74% (55-94) 85% (69-100) 12 47% (24-70) 85% (69-100) Median, months 10.2 (5.9-not estimable) Not reached Suspected EGFR mutant (n=19) 6 41% (19-64) 63% (41-85) 12 21% (0.1-41) 42% (18-66) Median, months 4.4 (2.6-8.0) 10.9 (3.9-21.0) Lower 95%CI for all 6-month PFS-rates exceed the pre-specified 15% minimum rate. 13% patients survived ≥18 months. 23% patients did not progress <12 months
Conclusion:
The toxicity rate was higher compared to that in fitter patients, but afatinib seems to improve PFS and OS in unfit EGFR-mutant NSCLC, and in suspected-positive patients who would otherwise only receive best supportive care.
