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Kumar Prabhash



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    MA02 - Improving Outcomes for Patients with Lung Cancer (ID 895)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Advanced NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 10:30 - 12:00, Room 201 BD
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      MA02.07 - Aprepitant for Cough Suppression in Advanced Lung Cancer: A Randomized Trial (ID 14540)

      11:10 - 11:15  |  Presenting Author(s): Kumar Prabhash

      • Abstract
      • Presentation
      • Slides

      Background
      Cough is a distressing symptom in patients with lung cancer. Effective management of cough leads to improvement in quality of life (QoL) and optimal palliative care. Aprepitant, a centrally acting neurokinin-1 inhibitor, has been shown in a pilot study to significantly decrease the cough frequency. a9ded1e5ce5d75814730bb4caaf49419 Method
      A randomized open-label study in patients with advanced lung cancer with cough for over 2 weeks despite therapy with a cough suppressant, with an ECOG performance status 0 to 2. Patients were randomized 1: 1 to Arm A: aprepitant 125 mg orally on day 1, followed by 80 mg orally on days 2 to 7 along with physician’s choice of antitussive therapy. Patients on Arm B received physician’s choice of antitussive therapy. Patients were evaluated at baseline and then on days 3, 7, 9 and 12. Primary efficacy endpoint was subjective improvement in cough, measured with the Visual Analog Scale (VAS) and the Manchester Cough in Lung Cancer Scale (MCLCS). Secondary endpoints included toxicity and QoL, measured by the EORTC QLQ-C30 and LC13. The trial was approved by the` institutional IEC and registered with (CTRI/2017/05/008691). 4c3880bb027f159e801041b1021e88e8 Result
      Between June 2017 and June 2018, 128 patients were randomized: 64 to each arm. The median age was 53 yrs, 65% male, 64% never-smokers, 82% had adenocarcinoma. 88% had Stage IV disease; 80% had PS 1 and 20% PS 2. The median duration of cough was 90 days. VAS scores at baseline and day 9 was 67.93, 38.50 in Arm A and 63.15, 48.57 Arm B , with p<0.001 and the MCLCS scores at baseline and day 9 was 30.03, 22.32 in Arm A and 27.53, 23.80 Arm B , with p<0.001. Overall, there was no significant difference in the QoL scores in patients in the two arms, however there was a significant improvement in the cough-specific QoL domain in the patients on the aprepitant arm, p=0.017. There was no increase in the grade 3 and higher adverse events in the patients on the aprepitant arm. 8eea62084ca7e541d918e823422bd82e Conclusion
      Aprepitant led to a significant improvement in cough in patients with advanced lung cancer, with no increase in severe side-effects. Aprepitant should be considered as one of the treatment options for cough in lung cancer patients. 6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)

    • 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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      P2.01-54 - Predictive Factors for Thromboembolism in Advanced Lung Cancer Patients on Platinum Chemotherapy: A Prospective Study (ID 11979)

      16:45 - 18:00  |  Author(s): Kumar Prabhash

      • Abstract
      • Slides

      Background

      Advanced lung cancer patients are predisposed to thrombosis due to many factors related to the disease and treatment, apart from the genetic and phenotypic factors. We aimed to determine the incidence of thromboembolic events (TEs) in advanced Non-Small Cell Lung Cancer (NSCLC) patients treated with platinum chemotherapy and study the baseline and treatment attributes predicting the onset of such events.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We evaluated advanced NSCLC patients on platinum chemotherapy for predetermined risk factors for thrombosis at baseline and routine visits. Patients with prior thromboembolism were excluded. The baseline patient characteristics were noted and patients were assigned to Khorana risk group as per the Khorana scores. The duration of follow up was until 4 weeks from the last chemotherapy. TEs occurring between the first dose of chemotherapy and 4 weeks after the last dose were considered as related. Predetermined factors associated with thromboembolism were studied in univariate analysis by chi square test.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 188 patients were screened, out of which 21 patients were excluded and two patients were lost to follow up. The mean age of was 57.5 years (range 30–79). Majority of the patients were male (83.2%) and either current or former smokers (62.3 %). 69.5% of patients had a normal Body mass Index (BMI) while 13.2 % were overweight (BMI 25-29.9 kg/m2) and 1.2 % were class I obese (BMI 30-34.9kg/m2). Majority of the patients (78.1%) belonged to the intermediate Khorana group (Risk score 1-2) while 23.0% belonged to high risk (Khorana score of ≥3) .Of the 165 patients who completed follow up, 67.8% received carboplatin-gemcitabine, 30.3% carboplatin-pemetrexed, 1.2% cisplatin-pemetrexed and 0.6 % carboplatin-paclitaxel. Median duration on platinum was 94 days (range 1-478). TE’s occurred in 4.8% of patients. Three patients developed venous pulmonary thromboembolism and 5 patients developed cerebral infarction, out of which 4 had arterial cerebral infarction and one patient had superior sagittal sinus thrombosis. The majority of events (7 out of 8) occurred within 100 days of starting chemotherapy. None of the presumed risk factors were found to be related to TEs on univariate analysis.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Despite the lower incidence of TEs in our study, exclusion of patients with prior thrombosis suggests de novo thrombosis on platinum chemotherapy .None of the predetermined risk factors for thrombosis were found to be statistically related to the occurrence of TEs, possibly due to the small number of events and sample size.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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