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F.M.N.H. Schramel



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    P1.05 - Poster Session with Presenters Present (ID 457)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 2
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      P1.05-032 - Quality of Life after Stereotactic Body Radiotherapy and Surgery in Patients with Early Stage Non-Small Cell Lung Cancer (ID 4947)

      14:30 - 15:45  |  Author(s): F.M.N.H. Schramel

      • Abstract
      • Slides

      Background:
      Several studies have shown that the clinical outcomes after stereotactic body radiotherapy (SBRT) are not inferior compared to surgery in patients with early stage non-small cell lung cancer (NSCLC). Quality of life (QoL) after treatment is an important parameter for patients which receives raising interest. We compared the QoL during the first year after treatment in patients with early stage NSCLC.

      Methods:
      Patients diagnosed with early stage NSCLC and treated with SBRT or surgery in the Sint Antonius Hospital between 2013 and 2015 were included. QoL assessments were performed before treatment, and at three, six and 12 months after treatment. QoL was evaluated by using the 30-item European Organization for Research and Treatment of Cancer Quality of life Core questionnaire and its corresponding 13-item lung cancer supplement. A linear mixed model was used to analyse the data and a change of more than five points was determined as minimal clinically important difference .

      Results:
      Ninety-three patients were included (SBRT n = 39, surgery n = 54). Patients who underwent SBRT were significantly older, had a higher ECOG performance status and a lower pulmonary function. The compliance for SBRT and surgery at baseline were 97% and 98% (p = 0.8), at three months 74% and 71% (p = 0.8), at six months 62% vs 78% (p = 0.1), and at 12 months 45% and 73% (p = 0.04). The ECOG performance status was not significantly different between the patients who were compliant and those who were not compliant. During the 12 months after treatment different significant changes were observed: QoL remained stable in SBRT patients and increased in surgical patients (p = 0.012) Role functioning increased in SBRT patients and decreased in surgical patients (p = 0.005) Cognitive functioning increased in SBRT patients and remained stable in surgical patients (p = 0.045) Social functioning remained stable in SBRT patients and decreased in surgical patients (p = 0.001) Pain increased in SBRT patients and decreased in surgical patients (p = 0.001) SBRT patients had a decrease in effect of pain medication and surgical patients had an increase in effect of pain medication (p = 0.0001).

      Conclusion:
      We showed that in patients with early stage NSCLC treated with SBRT or surgery the QoL scores showed different changes after treatment. In the light of the comparable clinical outcomes after both treatments these QoL aspects should be discussed with the patient before making a treatment-decision.

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      P1.05-065 - Usage of Chest Radiography or Computed Tomography in Post-Treatment Surveillance for Stage I and II NSCLC: Influence on Survival (ID 5524)

      14:30 - 15:45  |  Author(s): F.M.N.H. Schramel

      • Abstract

      Background:
      Survivors of stage I and II non-small-cell lung cancer (NSCLC) have higher risk of developing a recurrence of disease or a second primary lung cancer compared to the general population. Post-treatment surveillance (visits and radiological imaging) is needed for early recognition. Although a myriad of international guidelines exist regarding post-treatment surveillance no consensus has derived yet. The aim of this study was to further establish the appropriate follow-up modality: chest radiography with or without a computed tomography (CT) scan.

      Methods:
      In this retrospective study all patients diagnosed with a recurrence of previously treated stage I and II NSCLC between 2008 and 2014 at St Antonius Hospital, Nieuwegein the Netherlands, were included. We categorized patients after treatment in two imaging modality groups: one group received only chest radiographs (CR group) and the other group received ≥ one thoracic CT scan (CT group). The overall survival (OS), 1- and 3-yearssurvival and progression free survival (PFS) were compared between the groups by using the Kaplan-Meier survival, the log rank-test and the Cox proportional hazard model.

      Results:
      73 patients were enrolled; 50 patients in the CR group and 23 patients in the CT group. The median overall survival was 22.1 months (interquartile range (IQR) = 14.2-39.2 months) in the CR group compared to 27.2 months (IQR= 18.5-53.2 months) in the CT group (p = 0.12). After adjustment for the Eastern Cooperative Oncology Group (ECOG) performance score and morphology was made, both the overall survival (hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 0.76-2.70, p = 0.27) and the progression free survival (HR = 1.16, 95% CI = 0.65 – 2.07, p = 0.63) were not different in the CR group compared to patients in the CT group. There was no significant difference in the 1- and 3-yearssurvival either. The 1-yearssurvival was 80% in the CR group versus 91% in the CT group (HR = 5.50, 95% CI = 0.52-58.01, p = 0.16) and the 3-yearssurvival was 30% versus 39% (HR = 1.50, 95% CI = 0.74-3.01, p = 0.29).

      Conclusion:
      We showed that follow-up with a chest radiography, in patients with earlier diagnosed and curative treated stage I and II NSCLC, did not give inferior clinical outcomes compared to follow-up with a CT scan. Although more investigation is needed, this study might indicate that there is no need for a CT scan as standardized follow-up.

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    P1.06 - Poster Session with Presenters Present (ID 458)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P1.06-001 - Incidence of Molecular Testing and Outcomes of Treatment with Tyrosine Kinase Inhibitors in Advanced Non-Small Cell Lung Cancer in a Dutch Population (ID 6151)

      14:30 - 15:45  |  Author(s): F.M.N.H. Schramel

      • Abstract

      Background:
      Introduction: Tyrosine kinase inhibitors (TKIs) for treatment of advanced EGFR mutated adenocarcinoma were shown in many studies to be superior to chemotherapy in terms of progression-free survival. Since most data is derived from studies on Asian populations, there is a lack of data from other ethnicities. In the Netherlands the guidelines recommend that EGFR-mutation analysis should be performed in all patients with stage IIIb and IV adenocarcinoma and a non-small cell lung cancer-not otherwise specified(NSCLC- NOS). The aim of this study was to investigate the compliance to the guidelines in terms of determination of EGFR mutations, prevalence of EGFR mutations and the outcomes of treatment with the TKIs in a cohort of European patients with advanced NSCLC harboring an EGFR mutation.

      Methods:
      Methods: Data was obtained by retrospective analysis of the medical records of patients with a stage IIIb and IV non-small cell lung cancer between 2009 and 2014 in the two top-clinical hospitals in the Netherlands.

      Results:
      Results: The total number of patients included in the study was 1022. Molecular diagnostic tests were performed in 57.8% of patients with advanced adenocarcinoma or NSCLC-NOS. The prevalence of performing molecular diagnostic tests improved significantly between 2009 and 2014 (25,2% to 74,4% respectively). Positive EGFR mutation was found in 43 patients (in 9,1% of all molecular diagnostic tests performed). 72,1% of patients harboring an EGFR mutation were treated with TKIs.A significant overall survival benefit with a mean survival of 763 days was seen in EGFR positive patients treated with TKIs (with or without prior/subsequent chemotherapy) versus 435 days in patients treated with conventional chemotherapy (hazard ratio (HR): 0.719. 95% confidence interval (CI): 0.587-0.881). A large fraction of the patients with EGFR-mutated tumors were either initially or after progression treated with chemotherapy. EGFR positive patients who were prior to TKI treatment treated with chemotherapy had significantly longer survival in comparison to patients treated only with chemotherapy (1201 days vs 435 days respectively (HR: 3.289, 95% CI: 1.551-6.997). 10 patients were not treated with TKIs, either because of poor performance status (40%), patient’s refusal (30%), rapid disease progression (20%) or T790M mutation (10%).

      Conclusion:
      Conclusion: This study showed that incidence of molecular testing improved significantly over the course of the last years, leading to more effective targeted therapy. Overall survival was significantly prolonged in patients harboring an EGFR mutation treated with chemotherapy prior to TKIs, compared to patients without EGFR mutation treated only with conventional chemotherapy