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Gouri Shankar Bhattacharyya
Author of
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P2.01 - Advanced NSCLC (ID 618)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:00 - 16:00, Exhibit Hall (Hall B + C)
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P2.01-023 - Reasons for Withholding Systemic Therapy in Stage IV NSCLC: Comparison of Years 2004 to 2007 and 2010 to 2013 (ID 8702)
09:00 - 16:00 | Presenting Author(s): Gouri Shankar Bhattacharyya
- Abstract
Background:
Inspite of being the commonest cause of death among all cancer deaths, approximately 25% of Stage IV Lung cancer receive systemic therapy; although more than 60% of NSCLC present with Stage IV disease. Prospective randomised studies and meta-analysis have demonstrated survival and quality of life improvement in patients receiving systemic therapy. With significant advancement of molecular pathophysiology have opened up access to new systemic therapy like anti-EGFR, anti-ALK, and Immunotherapy. We conducted the study in Kolkata - to define the rates of patient referral to Medical Oncologists after diagnosis of Stage IV NSCLC. the rates of systemic therapy administration both standard chemotherapy and targeted therapy. the reason why a Stage IV NSCLC may not be referred to a Medical Oncologist or receive standard systemic therapy.
Method:
We performed chart review on Stage IV patients in Single Institute (Community Hospital) between 2004 to 2007 and 2010 to 2013. Staging was based on the 7th Edition of American Joint Committee for Cancer Staging. The 2 stages are based on availability and non-availability of TKIs freely. We collected baseline patient characters and compared median overall survival, referrals and treatment in these 2 cohorts.
Result:
900 patients from the period 2004 to 2007 and 800 patients for the period 2010 to 2013 were included (n=1700) in the 2 cohorts, In the 2 cohorts 60% vs 82% were referred for cancer care and 28% vs 74% received traditional therapy. There was a correlation between referral for cancer care and Medical Oncology with use of systemic therapy and survival, mOS = 11.2 months vs 1 month in those receiving systemic therapy. In those not receiving systemic chemotherapy the OS was 2 months vs 4 months. The major reasons for no referrals to Medical Oncology included poor functional status, rapid decline and doctors’ preference and patients’ preference. These were the similar reasons for patients not given systemic therapy. 9% vs 60% received EGFR inhibitors, those who received EGFR inhibitors had a mOS of 16.8 months. Multivariate analysis showed male sex (HR 1.16 p=0.008) and pulmonary embolism (HR 1.2 p=0.002) correlated with worse survival, while receiving chemotherapy (HR 1.2 p=<0.001) and having been enrolled in clinical trials (HR 0.76 p=0.049) correlated with better survival.
Conclusion:
We confirm that systemic therapy improves survival but as yet not been optimally used. Some modifiable factors would be improving referral guidelines, advocacy and patient teaching. There is a need for safe and effective therapy.
