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Bhagirathbhai Dholaria
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OA 06 - Global Tobacco Control and Epidemiology I (ID 662)
- Event: WCLC 2017
- Type: Oral
- Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
- Presentations: 2
- Moderators:G. Kovács, Yun Fan
- Coordinates: 10/16/2017, 15:45 - 17:30, Room 511 + 512
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OA 06.05 - Socioeconomic Factors Affecting Outcomes in Non-Small Cell Lung Cancer (NSCLC): A Large Population-Based Analysis (ID 9049)
15:45 - 17:30 | Author(s): Bhagirathbhai Dholaria
- Abstract
- Presentation
Background:
Disparities exist in cancer outcomes. NSCLC outcomes have improved in recent years but effects of socioeconomic factors have not been reported.
Method:
The National Cancer Database with NSCLC incident cases between 2004-2013 was analyzed. Overall survival (OS) was explored by several available factors with a focus on race and socioeconomic factors.
Result:
A total of 1,150,722 NSCLC patients were included with majority White (86.4%) followed by Black (10.6%) and a smaller proportion of Asians and Hispanics. Patients were evenly distributed among income quartiles and majority were insured (96.7%), lived in a metro area (81.7%) and treated at non-academic facilities (68.5%). Overall median OS was 13.1 months and significantly better for Asians (18.2 months) and Hispanics (16.6 months) as compared to Whites (13.2 months) and Blacks (11.5 months). (Figure 1, p<0.001) Outcomes were worse with higher comorbidity score, TNM stage and treatment at community or high-volume facility. Socioeconomic factors other than race associated with worse outcome included lower education and median income, uninsured status and Central geographic region. (Table 1) Figure 1 Figure 2
Conclusion:
In this largest analysis thus far, patient race and socioeconomic factors were found to significantly influence NSCLC survival. These must be addressed for equitable healthcare benefit and outcomes.
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OA 06.07 - Survival Trends Among Non-Small Cell Lung Cancer (NSCLC) Patients Over A Decade: Impact of Initial Therapy at Academic Centers (ID 10149)
15:45 - 17:30 | Author(s): Bhagirathbhai Dholaria
- Abstract
- Presentation
Background:
Treatment of NSCLC is rapidly advancing and academic centers are considered equipped with better expertise. NSCLC outcome trends in novel therapeutic era and impact of initial treatment at academic centers have not been reported.
Method:
The National Cancer Database (NCDB) with NSCLC incident cases between 2004-2013 was used. Overall survival (OS) was plotted by year of diagnosis and type of treatment facility, accounting for several available factors in NCDB.
Result:
A total of 1,150,722 NSCLC patients were included and separated by initial treatment facility type (academic: 31.5%, non-academic: 68.5%). Several characteristics were significantly different between the two cohorts (Table 1). Median OS for all patients was 13.1 months and improved significantly for those diagnosed in 2010-2013 (14.8 months) as compared to 2004-2009 (12.4 months) (p<0.001). Treatment at academic centers was associated with reduced risk of death [Multivariate HR=0.91 (95% CI 0.906-0.919), P<0.001]. Four-year OS for academic and non-academic cohorts was 25% and 19%, respectively (p<0.001), the difference more pronounced in stage 1-3. (Figure 1) Figure 1 Figure 2
Conclusion:
In this largest analysis thus far, NSCLC survival has improved over time and type of treatment facility significantly influences survival. Factors influencing treatment facility choice should be addressed for easier access to academic centers.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P1.07 - Immunology and Immunotherapy (ID 693)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Immunology and Immunotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.07-039 - Blood Biomarkers Correlate with Outcome in Advanced Non-Small Cell Lung Cancer Patients Treated with Anti PD-1 Antibodies (ID 9050)
09:30 - 16:00 | Author(s): Bhagirathbhai Dholaria
- Abstract
Background:
Anti-PD-1 antibodies have demonstrated improved overall survival (OS) and progression free survival (PFS) in a subset of patients with metastatic or locally advanced non-small cell lung cancer (NSCLC). Currently, no blood biomarkers in NSCLC predict clinical outcome to anti-PD-1 antibodies.
Method:
A retrospective analysis of locally advanced or metastatic NSCLC patients treated with anti-PD-1 antibodies at Mayo Clinic was performed. White blood cell count (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute neutrophil to lymphocyte count ratio (ANC/ALC), absolute eosinophil count (AEC), platelet counts and myeloid to lymphoid ratio (M:L) at baseline and throughout treatment were assessed. Kaplan–Meier and Cox regression analysis were performed.
Result:
157 patients were treated with nivolumab or pembrolizumab between 1/2015 and 4/2017. At median follow-up of 20 months, median OS and PFS were 13.4 and 2.6 months respectively. Higher baseline ANC, AMC, ANC/ALC ratio and M:L ratio significantly correlated with worse clinical outcomes. A baseline ANC/ALC ratio ≥ 5.9 had a significantly increased risk of death [hazard ratio (HR) = 1.65; 95% CI 1.06–2.56, p 0.027] and disease progression [HR = 1.65; 95% CI 1.17–2.34, p 0.005] compared with patients with ANC/ALC ratio <5.9. A baseline M:L ratio ≥ 11.3 had significantly increased risk of death [HR = 2.13; 95% CI 1.32–3.44, p 0.002] even after a multivariate analysis [HR = 1.89, p 0.015] compared to those with lower ratio. An increase from baseline values at 8 weeks for ANC [HR 1.10, p 0.006] and WBC [HR 1.11, p 0.004] was significantly associated with worse OS. Figure 1
Conclusion:
Increased baseline ANC/ALC ratio and M:L ratio were associated with poor PFS and OS in NSCLC patients treated with anti-PD-1 antibodies. The potential predictive value of these biomarkers might help with risk stratification, treatment strategies and warrant further investigation in a larger, prospective study.
