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Goetz H Kloecker
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OA01 - Improving Outcomes in Locoregional NSCLC I (ID 892)
- Event: WCLC 2018
- Type: Oral Abstract Session
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 10:30 - 12:00, Room 107
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OA01.07 - Updated Results of a Phase II Trial of Concurrent Chemoradiation with Consolidation Pembrolizumab in Patients with Unresectable Stage III NSCLC (ID 13961)
11:35 - 11:45 | Author(s): Goetz H Kloecker
- Abstract
- Presentation
Background
Concurrent chemoradiation (CRT) has been the standard Rx for pts with unresectable stage III NSCLC. A recent phase III trial (PACIFIC) of consolidation durvalumab [PDL-1 inhibitor] demonstrated improved median PFS vs. placebo (16.8 vs. 5.6 mo, HR 0.52, p<0.001). 12-mo (55.9% vs. 35.3%) and 18-mo (44.2% vs. 27%) PFS were also improved. Toxicity was manageable with a grade 3-4 pneumonitis rate of 3.4%, and 4 patients experienced grade 5 pneumonitis. We report updated results of a phase 2 trial of consolidation pembrolizumab [PD-1 inhibitor] following concurrent CRT in patients with unresectable stage III NSCLC.
a9ded1e5ce5d75814730bb4caaf49419 Method
After completion of CRT with carboplatin/paclitaxel, cisplatin/etoposide, or cisplatin/pemetrexed + 59-66.6 Gy XRT, those pts w/o PD after 4-8 weeks off CRT received pembro 200 mg IV q3wk for up to 1 yr. The primary endpoint was time to metastatic disease or death [TMDD]. Key secondary endpoints included PFS, OS, and toxicity.
4c3880bb027f159e801041b1021e88e8 Result
93 pts enrolled [92 eligible for efficacy analysis]. Median f/u was 18.6 mo and median age 66 (45-84). 64.1% male and 35.9% female. Stages were 59.8% IIIA and 40.2% IIIB. 55.4% non-SqCC and 43.5% SqCC with 1 mixed histology. 94.6% were current/former smokers. Chemo regimens included carbo/pac (71.7%), cis/etop (26.1%), cis/pemetrexed (2.2%). Median number of cycles of pembro was 13.5 [1-19]. 16% received < 4 cycles; 84% received > 4 cycles; 37% completed 1 yr pembro. Median TMDD was 22.4 months (95% CI 17.9-NR). Median OS was NR (95% CI 22.4-NR), and the estimates of 1-yr and 2-yr OS were 81% and 61.9% respectively. Median PFS was 17 months (95% CI 11.9-NR). 12, 18, and 24-month PFS were 60.2%, 49.9%, and 44.6% respectively. 16 (17.2%) pts developed G≥2 pneumonitis, 5 (5.4%) had G3-4 pneumonitis. There was 1 pneumonitis-related death. In those developing G≥2 pneumonitis, the median time was 8.4 wks [1.1-48.3]. No other G 3/4 toxicities exceeded 5% except dyspnea (5.4%).
8eea62084ca7e541d918e823422bd82e Conclusion
Consolidation pembrolizumab following CRT substantially improves TMDD and PFS compared with historical controls. Prelim OS data is promising and suggests a substantial gain in outcomes of patients with stage III NSCLC is possible with consolidation pembrolizumab. These data will be updated further prior to the World Conference on Lung Cancer Meeting.
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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: 2
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.15-02 - Migration Differences in Small Cell vs Non-Small Cell Lung Cancer (ID 13035)
16:45 - 18:00 | Author(s): Goetz H Kloecker
- Abstract
Background
Every year there is a population diagnosed with lung cancer (LC) that does not receive initial treatment upon diagnosis and then “migrates” to other hospital systems before ultimately getting treatment. We aimed to compare migration rates between non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) and potential factors associated with migration.
a9ded1e5ce5d75814730bb4caaf49419 Method
As part of the Kentucky Lung Cancer Education Awareness Detection Survival (LEADS) Collaborative, 29 of 32 Kentucky hospital registries contacted provided LC data of 7660 patients from 2012-2014. Data collected included age at diagnosis, stage, overall survival (OS), sex, race, insurance and treatment history. Treatment included any combination of surgery, radiation, or chemotherapy. Hospital records were matched to Kentucky Cancer Registry records to determine the number of hospitals visited for treatment. Patient treatment and migration patterns were analyzed with a logistic regression model along with additional post-hoc analysis. Difference in rates was calculated by chi-square test.
4c3880bb027f159e801041b1021e88e8 Result
Among the 7660 LC patients, 81% were NSCLC and 19% were SCLC. Most patients were treated at their initial hospital - NSCLC (73%) and SCLC (82%) (p value<0.01). However, among the untreated patients, 616 (36%) of NSCLC patients migrated to a different hospital compared to only 23 (8%) of SCLC patients (p value<0.01). Migration of NSCLC patients to another hospital was associated with Stage I-III disease, younger age (66.4 vs 72.2 years), with initial hospitals missing treatment modalities and patients having private insurance. In NSCLC, compared to patients treated initially, patients treated after migration lived longer (591 vs 505 days) and particularly had longer survival with stage III (563 vs 495 days) and IV disease (379 vs 300 days). Too few patients with SCLC migrate to assess association with OS and other patient characteristics.
8eea62084ca7e541d918e823422bd82e Conclusion
There is a significant difference in rates of initial treatment between NSCLC and SCLC that could be due to perceived urgency to treat SCLC. This analysis shows highly significant 4-fold increase in migration rate of NSCLC as compared to SCLC. This could be explained by newer and better treatment options available at referral centers for NSCLC and a lack of these options for SCLC. Increasing research and new innovations in NSCLC will likely drive more patients to migrate in future.
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P1.15-23 - Factors Affecting Treatment in Non-Small Cell Lung Cancer Patients (ID 14054)
16:45 - 18:00 | Author(s): Goetz H Kloecker
- Abstract
Background
Lung cancer continues to be the leading cause of cancer deaths with Kentucky having the highest incidence of lung cancer. Despite advances in treatment and subsequent survival improvements, a significant number of non-small cell lung cancer (NSCLC) patients remain untreated. Factors such as age, stage at diagnosis and insurance status appear to play an important role in this disparity.
a9ded1e5ce5d75814730bb4caaf49419 Method
In the Kentucky LEADS Collaborative, 27 of 31 (81%) Kentucky hospital registries provided all NSCLC data from 2012-2015. Variables collected included hospital accreditation by the Commission on Cancer (CoC), patient age at diagnosis, stage, race, number of comorbidities, insurance status, and overall survival (OS). Treatment included combinations of surgery, radiation, chemotherapy or immunotherapy. Hospital records were matched to the Kentucky Cancer (KCR) records and analyzed with a logistic regression model along with additional post-hoc analysis.
4c3880bb027f159e801041b1021e88e8 Result
Of the 13,975 patients diagnosed with NSCLC, 10,367 (74.2%) were treated leaving 3,608 (25.8%) untreated. Overall survival reported as person-days was significantly longer for the treated versus untreated patients (593 days vs 161 days). Neither race nor gender showed statistical significance while age at the time of diagnosis was significant with the untreated patients being diagnosed at a mean age of 72 and the treated patients at a mean age of 66 (p=<0.001). The mean average of comorbidities reported was 4.1 for treated patients and 4.4 for untreated patients though the specific comorbidities were not discernable. Treatment versus lack of treatment was also significantly associated with stage at the time of diagnosis with 87.9% vs 12.1% for stage I, 88.2% vs 11.8% for stage II, 73.9% vs 26.1% for stage III, and 64.2% vs 35.8% in stage IV; untreated patients tended to present at a later stage than those who received treatment with OR 2.91 (95% CI 2.57-3.28) for stage III and OR 4.28 (95% CI 4.29-5.41) for stage IV. Lastly, insurance proved to be an important factor with untreated patients more likely to have Medicaid, Medicare or be uninsured.
8eea62084ca7e541d918e823422bd82e Conclusion
Treatment for lung cancer is correlated with improved outcomes and yet a large number of patients are still untreated. We aimed to assess these barriers to treatment and found untreated patients were more likely to be older, diagnosed at a later stage, and not have private insurance. While therapies are constantly changing and improving, it is important to factor in the many barriers that still exist in preventing patients from being treated.
6f8b794f3246b0c1e1780bb4d4d5dc53
