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R.C. Miller



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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: 1
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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): R.C. Miller

      • Abstract
      • Presentation
      • Slides

      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.

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    P2.14 - Radiotherapy (ID 715)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Radiotherapy
    • Presentations: 1
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      P2.14-006 - A Pilot, Randomized Trial of Daily Lisinopril vs Placebo to Prevent Radiation-Induced Pulmonary Distress (Alliance MC1221) (ID 8868)

      09:30 - 16:00  |  Author(s): R.C. Miller

      • Abstract

      Background:
      We report the results of a randomized, placebo-controlled pilot study for measuring the effect of lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, on pulmonary distress in patients receiving thoracic radiotherapy (TRT) with or without chemotherapy. We aimed to evaluate the practicality for developing a larger-scale, randomized phase III study in the future.

      Method:
      Twenty-three (23) eligible patients receiving TRT (≥45 Gy) for predominantly non-small cell lung cancers were enrolled; an ECOG performance of 2 or better was required. The patients were randomized to receive either 20 mg of lisinopril or placebo once daily during and up to 3 months post-RT. The trial stopped early due to lower accrual than anticipated. The baseline and weekly during RT patient-reported outcome (PRO) results for Symptom Experience Questionnaire (SEQ), Lung Cancer Symptom Scale (LCSS), the EORTC for Lung Cancer Questionnaire (EORTC-QLQ-LC13), and Function Assessment of Cancer Treatment were analyzed. Adverse events (AE) were measured according to CTCAE v4.0. Our primary endpoint was safety and AE profile of lisinopril, followed by PRO comparisons; multiple comparisons for secondary analyses were not adjusted.

      Result:
      There were 11 and 12 eligible patients on the placebo and lisinopril arms, respectively. Mean age was 63.5 years; 13 (62%) were male. Eighteen (86%) were either former or current smokers. All baseline characteristics were balanced. All baseline PRO results were balanced except for more shortness of breath by SEQ/LCSS which were slightly worse in the placebo arm. The placebo patients reported more dyspnea on climbing stairs at baseline on EORTC-QLQ-LC13. The incidences of grade 2 hypotension were 2 vs. 4 patients for placebo and lisinopril, respectively (P=0.26). One (1) patient taking lisinopril had grade 2 acute kidney injury (P=0.20). One (1) patient developed grade 4 dyspnea on placebo arm. No patients experienced grade 5 toxicities. Patients taking lisinopril did not have more cough or allergic reaction. Acute respiratory distress as measured by worst dyspnea score was poorer in placebo vs. lisinopril patients (42.0 vs. 77.5 respectively, P=0.006). The rest of the PRO indices were with no clinically meaningful differences between arms.

      Conclusion:
      Although this novel trial was underpowered which was not intended, the results provided a strong signal for safety and perhaps even efficacy, by PRO, in concurrently administering lisinopril, an ACE inhibitor, for advanced lung cancer patients who require RT-based therapies. Using lisinopril for mitigating or preventing radiation-induced pulmonary distress or pneumonitis will require future trial testing. Support: UG1CA189823.