Virtual Library

Start Your Search

Andrew Warner



Author of

  • +

    OA06 - Early Stage Lung Cancer: Outcomes and Interventions (ID 902)

    • Event: WCLC 2018
    • Type: Oral Abstract Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 13:30 - 15:00, Room 202 BD
    • +

      OA06.06 - MISSILE-NSCLC: A Phase II Trial Measuring the Integration of Stereotactic Radiotherapy Plus Surgery in Early-Stage Non-Small Cell Lung Cancer (ID 13028)

      14:25 - 14:35  |  Author(s): Andrew Warner

      • Abstract
      • Presentation
      • Slides

      Background

      Stereotactic Ablative Radiotherapy (SABR) has emerged as a standard treatment option in patients with medically inoperable early-stage non-small cell lung cancer (NSCLC), yet the pathologic complete response (pCR) rate after SABR is unknown. Neoadjuvant SABR in operable patients has been proposed as a mechanism of improving local control and inducing anti-tumor immune activity.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This phase II study (NCT02136355) enrolled patients with biopsy-proven clinical T1-2N0M0 NSCLC who were candidates for surgical resection. Patients underwent neoadjuvant SABR using a risk-adapted fractionation of 54 Gy/3 fractions, 55 Gy/5 or 60 Gy/8. Surgical resection took place 10 weeks after SABR. Patients also underwent dynamic FDG-PET and dynamic contrast-enhanced CT prior to SABR and approximately 2 weeks prior to surgery. The primary endpoint was the pCR rate, and secondary endpoints included local, regional, and distant recurrence, quality of life using the FACT Trial Outcome Index (TOI), and toxicity.

      4c3880bb027f159e801041b1021e88e8 Result

      Accrual began in Sept 2014 and completed in August 2017 with 40 patients enrolled. Median age was 69 years (range 44–83 years), and 58% were female. Thirty-one patients (78%) had T1 tumors and 9 (23%) had T2 tumors; histology was adenocarcinoma (n=26; 65%), squamous cell (n=13; 33%) and NSCLC not otherwise specified (n=1; 3%). Baseline FEV1 was median 73% percent predicted (range 50%–117%). Nine patients (23%) received the 3-fraction regimen, 21 (53%) received 5 fractions and 10 (25%) received 8 fractions. Thirty-five patients underwent surgery and were evaluable for the primary endpoint. The pCR rate was 60% (95% CI 44%–76%). 30-day and 90-day post-surgical mortality rates were both 0%. Eighteen percent of patients had grade 3 or 4 toxicities, most commonly pulmonary in nature (Grade 4: atelectasis and respiratory failure [n=1]; Grade 3: pneumonia/pneumonitis [n=2]; bronchopleural fistula [n=1]). In the patients receiving surgery, 2-year outcomes were: overall survival 77%, local control 100%, regional control 53% and distant control 76%. There were no significant changes in FACT-TOI score within the first year of follow-up.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The pCR rate after SABR for T1 and T2 NSCLC was 60%. Toxicity of the combined approach appears favorable, compared to historical series of surgery alone, and there was no perioperative mortality. Larger studies are needed to determine the clinical role of this combined treatment approach.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      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.

      Only Active 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 or select "Add to Cart" and proceed to checkout.

  • +

    P2.12 - Small Cell Lung Cancer/NET (Not CME Accredited Session) (ID 961)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
    • +

      P2.12-10 - Novel Prognostic Model for Limited-Stage Small-Cell Lung Cancer (ID 13999)

      16:45 - 18:00  |  Author(s): Andrew Warner

      • Abstract
      • Slides

      Background

      There is currently no prognostic model designed specifically for patients with limited-stage small cell lung cancer (SCLC). The objective of this study was to construct a novel prognostic model for this patient population using baseline characteristics readily available in clinic.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      An institutional retrospective consecutive patient database was constructed by reviewing the charts of patients diagnosed with limited-stage SCLC between January 2000 and December 2013. Baseline patient characteristics, treatment details and outcomes were extracted. The primary endpoint for the prognostic model was overall survival (OS) and the secondary endpoint was progression-free survival (PFS). Univariable and multivariable Cox regression analyses were performed to identify variables associated with OS and PFS. Prognostic models were generated using recursive partitioning analysis (RPA).

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 398 patients were eligible for analysis. Median follow-up was 8.2 years. The median age was 67 (range: 40-87). Overall, 94% of patients received chemotherapy, 82% received radiotherapy and 65% received both concurrently. Both hypofractionated (40 Gy in 15 fractions) and conventionally-fractionated (50-66 Gy in 25-33 fractions) radiotherapy were used. Prophylactic cranial irradiation was used in 45% of patients. The median OS for the entire cohort was 15.4 months, with a 5-year OS of 19.7%. Overall median PFS was 9.3 months, with a 5-year PFS of 14.1%. On multivariable Cox regression, age, Eastern Cooperative Oncology Group (ECOG) performance status, tumor location and baseline presence of any pleural effusion (non-malignant or unknown status) were prognostic of OS, while performance status and T-stage were prognostic of PFS. RPA model of OS divided patients into favorable (ECOG 0-2, no pleural effusion, middle/upper lobe location: 5-year OS 31%), intermediate (ECOG 0-2, no pleural effusion, non-middle/upper lobe location: 5-year OS 21%) and unfavorable (ECOG 3-4 or any pleural effusion: 5-year OS 5-8%) groups (log-rank p < 0.001). RPA for PFS divided patients into favorable (ECOG 0-2, <=T3: 5-year PFS 21%) and unfavorable (ECOG 3-4 or T4: 5-year PFS 5-9%) groups (log-rank p < 0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Novel prognostic factors for OS and PFS based on baseline patient characteristics were successfully identified for patients with limited-stage SCLC. RPA prognostic models were able to separate patients into distinct risk groups for OS and PFS. Our results will benefit from further external validation and can be useful in stratifying patients in future prospective studies.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Active 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 or select "Add to Cart" and proceed to checkout.