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Catherine Labbe



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    ES03 - How to Manage Pleural Plaques and Pleural Effusion with Negative Pleural Biopsy (ID 771)

    • Event: WCLC 2018
    • Type: Educational Session
    • Track: Mesothelioma
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 15:15 - 16:45, Room 206 AC
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      ES03.03 - When to Repeat Pleural Biopsies (ID 11363)

      15:45 - 16:00  |  Presenting Author(s): Catherine Labbe

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    MA18 - Modelling, Decision-Making and Population-Based Outcomes (ID 920)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 13:30 - 15:00, Room 201 F
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      MA18.09 - Predictors of Health Utility Scores (HUS) in Advanced EGFR-Mutated NSCLC. (ID 13087)

      14:25 - 14:30  |  Author(s): Catherine Labbe

      • Abstract
      • Presentation
      • Slides

      Background

      Advanced NSCLC patients with EGFR mutations (EGFRm) are currently treated with first - to third-generation tyrosine kinase inhibitors (TKIs). In the advanced setting, quality of life is an important goal; we therefore evaluated determinants of HUS in this population.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      In a prospective, observational study, patients with advanced EGFRm NSCLC completed EQ-5D surveys at outpatient visits generating HUS (range 0-1). Patients were allowed to enrol at any point in their disease course. Baseline clinical characteristics and outcome data were extracted from chart review. Patient imaging was reviewed and health states (stable/progressing) at each encounter recorded. Univariable analyses conducted using ANOVA and multivariable regression analyses with generalized estimating equations identified factors associated with HUS.

      4c3880bb027f159e801041b1021e88e8 Result

      From November 2014 to July 2017, 782 encounters (follow-up visits) were collected for 244 patients. Median age at first encounter was 64 years (range:29-96); 54% were female and 54% Asian. Median time from diagnosis of stage IV NSCLC to first encounter was 23 months (range:0-67). The median number of HUS collected per patient was 2 (range:1-14). For patients with multiple visits the median time between completed questionnaires was 1.8 months (1-18). 105 patients (43%) presented with or developed brain metastases during the study period. In a univariable analysis, regardless of treatment line, mean HUS (mHUS) on osimertinib was 0.85 (standard deviation (SD):0.15) (n=33 patients; 114 encounters) compared to mHUS=0.80 (SD:0.17) on gefitinib (n=147, 351 encounters); mHUS=0.72 (SD:0.16) on chemotherapy (n=32, 76 encounters); and mHUS=0.79 (SD=0.15) on other TKIs (n=49, 133 encounters); p<0.001. In a multivariable analysis, disease progression (p=0.04) and ECOG performance status >0 (p<0.001) were associated with lower HUS. In contrast, treatment with osimertinib (when compared to a reference group of first-generation TKIs, gefitinib/erlotinib) was associated with improved HUS (p=0.01), while line of therapy and number of metastatic sites of disease were not associated with HUS. In addition, brain metastases had no significant impact on HUS (p=0.33).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Progressive disease and worse performance status associate with lower HUS in patients with EGFRm NSCLC. Patients treated with osimertinib had the highest HUS when compared with a reference group of first-generation EGFR TKIs regardless of line of therapy. These results may help in the choice of EGFR-TKI, especially in patients with a poor performance status.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P1.01 - Advanced NSCLC (Not CME Accredited Session) (ID 933)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.01-42 - Real-World Evaluation of Tolerability in Older Adult Patients (≥75 Years Old) with EGFR-mutated NSCLC (ID 13289)

      16:45 - 18:00  |  Author(s): Catherine Labbe

      • Abstract
      • Slides

      Background

      NSCLC patients carrying EGFR mutations are diagnosed across a wide age distribution. Although EGFR tyrosine kinase inhibitors (TKIs) are generally well tolerated, there remains a paucity of real-world data on toxicity and health utility scores (HUS) in older patients.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A longitudinal observational study evaluated health-related quality of life (HRQoL) using HUS through the EQ-5D questionnaire, and common EGFR-TKI toxicities using PRO-CTCAE in NSCLC outpatients carrying EGFR mutations. Patients were classified into two groups: older (>75 years) and younger (<75 years). Patient characteristics and outcomes were extracted from chart review; patients were classified as having stable or progressive disease according to imaging findings. HUS and PRO-CTCAE results were compared descriptively.

      4c3880bb027f159e801041b1021e88e8 Result

      Of 240 patients and 774 encounters, 52 patients (22%; comprising 157 encounters) were aged ≥ 75 years. Gender and race were similarly distributed in both age groups: 63% of older patients and 70% of younger (<75 years) were female; 56% of older patients and 53% of younger patients were Asian. Use of gefitinib in older patients was much higher than other drugs: among 147 patients who received gefitinib, 27% (40 patients) were older, compared to 15% (5/33) for osimertinib and 15% (3/20) for erlotinib. Of patients receiving afatinib (n=11) and chemotherapy (n=32), none were ≥ 75 years. The following table describes HUS and PRO-CTCAE results by treatment and age group for stable patients.

      Older Adults (75 years)

      Younger Adults (<75 years)

      N

      HUS, mean (SD)

      PRO-CTCAE*, median [IQR]

      N

      HUS, mean (SD)

      PRO-CTCAE*, median [IQR]

      Stable on gefitinib

      34

      0.83 (0.20)

      4.5 [0,16]

      77

      0.80 (0.15)

      4 [0,15]

      Stable on osimertinib

      5

      0.80 (0.23)

      13.5 [0,17]

      22

      0.87 (0.12)

      0 [0,13.5]

      Stable on erlotinib

      3

      0.82 (0.08)

      0 [0,9]

      11

      0.80 (0.14)

      0 [0,16]

      *Higher PRO-CTCAE indicates more severe toxicities/symptoms.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In a real-world evaluation, patients 75 years or older comprised almost a quarter of all patients with EGFR-mutant advanced NSCLC. Afatinib and chemotherapy were not used at all in this population. Gefitinib was used most commonly, with similar toxicities and health utilities between older and younger patients. Osimertinib and erlotinib were used too infrequently in this study for conclusive age comparisons.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P1.13 - Targeted Therapy (Not CME Accredited Session) (ID 945)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.13-11 - PRO-CTCAE Toxicities in Advanced NSCLC Patients with EGFR Mutations: A Real World Assessment (ID 12998)

      16:45 - 18:00  |  Author(s): Catherine Labbe

      • Abstract
      • Slides

      Background

      The Patient Reported Outcomes of the CTCAE (PRO-CTCAE) tool has not been evaluated in a real-world study of EGFR-mutation positive patients treated with TKIs/chemotherapies. We evaluated its role in capturing clinically-significant toxicities.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A longitudinal observational study evaluated common EGFR-TKI toxicities using PRO-CTCAE, measured on a five-point scale (1=no symptoms to 5=very severe symptoms) in outpatients with EGFR-mutated (EGFRm) advanced NSCLC.

      4c3880bb027f159e801041b1021e88e8 Result

      Toxicity information was collected for 709 follow-up visits (encounters) from 232 patients. Median age was 64 (range:29-96), 161 (69%) were female and 124 (53%) were Asian. 85 (37%) already had brain metastases at first encounter. 485 encounters were observed from patients stable on treatment, and 187 from patients progressing or with documented progression on their current treatment. 24 patients were treated with osimertinib (97 encounters, 97% in second/subsequent-line), 136 with gefitinib (324 encounters, 95% in first line therapy), 42 were receiving other EGFR-TKIs (118 encounters, 53% in second/subsequent-line), and 29 with chemotherapy (73 encounters, 96% second/subsequent-line). The table below summarizes the treatment-related PRO-CTCAE toxicities self-graded as moderate-to-very-severe by EGFRm patients.

      Proportion of patients reporting highest grade of toxicity as grade 3-5, by PRO-CTCAE

      Gefitinib

      Osimertinib

      Other EGFR TKI

      Chemotherapy

      Diarrhea

      17%

      18%

      24%

      8%

      Constipation

      12%

      4%

      12%

      16%

      Decreased appetite

      10%

      7%

      14%

      26%

      Nausea

      6%

      3%

      4%

      24%

      Vomiting

      1%

      2%

      3%

      16%

      Fatigue

      18%

      12%

      23%

      42%

      Numbness and Tingling

      6%

      7%

      10%

      16%

      Skin Rash

      23%

      12%

      20%

      9%

      Visual Disorders

      (includes dry eye)

      4%

      0%

      3%

      4%

      Total PRO-CTCAE Score, MEDIAN [IQR]

      4 [0,16]

      0 [0,15]

      6 [0,17]

      10 [0,21]

      8eea62084ca7e541d918e823422bd82e Conclusion

      Osimertinib therapy had the most favorable self-reported toxicity profiles of all the therapies in EGFRm patients, followed by gefitinib. Chemotherapy generated the greatest toxicities. The use of PRO-CTCAE was well-accepted by patients in a clinical setting. This confirms trial data supporting favorable toxicities with osimertinib compared to other therapies for EGFRm NSCLC patients.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P1.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 947)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.15-13 - Wait Times for Diagnosis and Treatment of Lung Cancer Across the Province of Quebec, Canada (ID 13472)

      16:45 - 18:00  |  Presenting Author(s): Catherine Labbe

      • Abstract
      • Slides

      Background

      Multiple clinical practice guidelines recommend rapid evaluation of patients with suspected lung cancer. Diagnostic pathways and wait times vary considerably from one centre to another.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively reviewed medical records of all patients (n=1217) across the province of Quebec who had a biopsy-proven diagnosis of lung cancer between February 1st and April 30th, 2017. Median wait times for diagnosis and treatment were calculated.

      4c3880bb027f159e801041b1021e88e8 Result

      Patient characteristics are shown in Table 1. Median wait times for investigation and treatment are shown in Table 2. There were variations between centres and regions.

      Characteristic

      No (%)

      Age, years, mean (range)

      68.5 (20-94)

      Male sex

      585 (48)

      Smoking status

      Former or current smoker

      Never smoker

      Unknown

      1120 (92)

      60 (5)

      37 (3)

      ECOG performance status

      0

      1

      ≥2

      Missing

      416 (34)

      358 (30)

      393 (32)

      50 (4)

      Histology

      Adenocarcinoma

      631 (52)

      Squamous cell carcinoma

      284 (23)

      NSCLC NOS

      70 (6)

      SCLC

      178 (15)

      Other

      54 (4)

      TNM stage

      I

      213 (18)

      II

      114 (9)

      III

      227 (19)

      IV

      475 (39)

      Limited SCLC

      40 (3)

      Extensive SCLC

      138 (11)

      Missing

      10 (1)

      Known positive EGFR mutation status (n=395 tested)

      Known positive ALK translocation status (n=387 tested)

      PD-L1 TPS (n=386 tested)

      <1%

      1-49%

      ≥50%

      Number of investigations per patient, median (IQR)

      28 (7)

      6 (2)

      85 (22)

      151 (39)

      150 (39)

      7 (6, 8)

      Tumor board review

      194 (16)

      Final diagnostic procedure

      Flexible bronchoscopy

      338 (28)

      EBUS/EUS

      223 (18)

      Transthoracic needle biopsy

      301 (25)

      Thoracoscopy

      139 (11)

      Biopsy of metastatic site

      145 (12)

      Sputum cytology

      1 (0)

      Thoracentesis

      61 (5)

      Mediastinoscopy

      Missing

      2 (0)

      7 (1)

      ECOG = Eastern Cooperative Oncology Group; NSCLC = non-small cell lung cancer; NOS = not otherwise specified; SCLC = small cell lung cancer; EGFR = epidermal growth factor receptor; ALK = anaplastic lymphoma kinase; TPS = tumor proportion score; IQR = interquartile range; EBUS = endobronchial ultrasonography; EUS = endoscopic ultrasonography.

      Table 2 – Median wait times for investigation and treatment

      Investigation or treatment interval

      Pts (n)

      Median wait, days (IQR)

      Referral to first appointment with specialist

      972

      2 (0, 7)

      First appointment to diagnosis

      1152

      18 (8, 43)

      Diagnosis to first treatment

      930

      22 (5, 42)

      Referral to first treatment

      737

      58 (28, 89)

      Abnormal imaging to first treatment

      902

      72 (39, 111)

      Surgery

      268

      109 (80, 142)

      Radiation

      362

      59 (28, 98)

      Systemic therapy

      330

      62 (35, 92)

      8eea62084ca7e541d918e823422bd82e Conclusion

      To our knowledge, this is the largest multicentre review of wait times for diagnosis and treatment of lung cancer with detailed characteristics of patients. Data will be completed and updated prior to the meeting, to try to identify specific factors associated with longer wait times.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.15-10 - Determinants of Health Utility Scores (HUS) in Patients with ALK Rearranged Non-Small Cell Lung Cancer. (ID 14025)

      16:45 - 18:00  |  Author(s): Catherine Labbe

      • Abstract
      • Slides

      Background

      Despite an increasing number of available treatment options for patients with advanced ALK-rearranged (ALKr) NSCLC, the goals of care remain to improve survival whilst maintaining quality of life. With rapidly changing management and prognosis, understanding the impact of treatments on quality of life becomes important. We evaluated factors affecting health utility scores (HUS) in this generally younger cohort of patients with NSCLC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      An ongoing prospective observational/real-world cohort study at the Princess Margaret Cancer Centre is enrolling patients with advanced NSCLC. Patients are asked to complete the EQ5D questionnaire at each outpatient visit. During the period from November, 2014 to March, 2018, patients with ALKr who participated were analyzed. Baseline clinical characteristics, oncological treatment, and outcomes were extracted from chart review. Factors associated with HUS were identified using ANOVA.

      4c3880bb027f159e801041b1021e88e8 Result

      272 encounters (follow-up visits) in 43 ALK+ patients were analysed. The median age at diagnosis was 56 years (range: 31-79 years). Half the patients in our sample were female (49%), and the majority were never-smokers (84%); 44% of the cohort were Asian. During the study period, 24 patients (56%) presented with or developed brain metastases. The median number of HUS collected per person was 4 (range: 1-20). Among patients who were stable on treatment, there were no statistically significant differences in mean HUS (mHUS) between different ALK inhibitors: mHUS [SD, standard deviation] were: mHUS of crizotinib=0.82 [0.08] (n=25, 92 encounters); mHUS of ceritinib=0.79 [0.14] (n=17, 102 encounters); and mHUS of other ALK inhibitors=0.80 [0.17] (n=12, 25 encounters), which included mHUS of alectinib=0.79 [0.20] (n=8, 10 encounters). The number of previous lines of treatment did not impact HUS (p=0.85). Patients stable on treatment who received prior whole brain radiation (n=14) had lower mHUS compared to those who never had WBRT (mHUS=0.78 [0.14] vs. 0.84 [0.10]; p=0.05), which may partly explain differences in mHUS by sex (64% of patients who had received WBRT were female vs 41% who did not receive WBRT): males=0.84 [0.10] vs females=0.78 [0.14], p=0.04. In 11 stable patients who had received radiation to bone metastases mHUS was 0.75 [0.16] vs. 0.84 [0.09] in those who did not (p=0.006).

      8eea62084ca7e541d918e823422bd82e Conclusion

      In this study, mean HUS were similar across different ALK inhibitors. Female patients and those receiving whole brain radiation or radiation to bone had lower HUS. This highlights specific factors that influence health-related quality of life in this subset of patients with advanced NSCLC

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.04 - Immunooncology (Not CME Accredited Session) (ID 970)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.04-20 - Correlation of Immune-Related Adverse Events and Response from Immune Checkpoint Inhibitors in Patients with Advanced NSCLC (ID 14138)

      12:00 - 13:30  |  Author(s): Catherine Labbe

      • Abstract
      • Slides

      Background

      Immune checkpoint inhibitors (ICIs) are associated with a unique set of toxicities termed immune-related adverse events (irAEs). The association between response to ICI therapy and development of irAEs has been documented in various cancer types.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Stage IV non-small cell lung cancer (NSCLC) patients treated with ICIs at the Princess Margaret Cancer Centre between 2013 and 2016 were followed for treatment response, treatment duration, survival, and toxicity. The relationship between treatment outcomes and occurrence of irAEs was examined.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 97 advanced NSCLC patients were followed. Most patients (81%) received anti-PD-1 agents, 17% received anti-PD-L1 agents, and 2% received combination anti-PD-L1 plus anti-CTLA-4 therapy. Median follow up for the cohort was 5.1 months (0.3-38.1 months) from treatment start. Demographic and tumour characteristics were balanced between the groups. IrAEs occurred in half of patients (51%) on ICIs and grade≥3 irAEs in 7%. The most commonly observed irAEs were arthralgia (13%), diarrhea/colitis (12%), and skin rash (11%). Discontinuation of treatment due to irAEs occurred in 10% of patients, half of whom experienced grade≥3 irAEs.

      The overall response rate to ICIs was 23%, with the majority occurring by week 8 of treatment (16/22). Response was non-evaluable in one patient and this was excluded from response analysis. Patients with grade≥3 irAEs were more likely to have response to treatment compared to those with grade I/II irAEs and no irAEs (67% vs 17% vs 23%, p=0.035), Table 1. Smoking status was not associated with response rate or frequency of irAEs. Median survival was not reached in those with grade≥3 irAEs, 15.7 months in those with grade I/II irAEs, and 7.4 months in those with no irAE (p=0.16). Duration of treatment did not differ significantly among the groups.

      table 1. relationship between immune-related adverse events (irae) and response to treatment.jpg

      8eea62084ca7e541d918e823422bd82e Conclusion

      The occurrence of grade≥3 irAEs may be associated with treatment response in advanced NSCLC patients undergoing ICI therapy.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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