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Monica Blake
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MA08 - Clinical Trials in Brain Metastases (ID 906)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 15:15 - 16:45, Room 203 BD
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MA08.02 - Prophylactic Cranial Irradiation Reduces the Risk of Brain Metastases in High-Risk Lung Cancer Patients: EGFR and ALK Mutations (ID 13496)
15:20 - 15:25 | Author(s): Monica Blake
- Abstract
- Presentation
Background
Prophylactic Cranial Irradiation (PCI) is considered standard-of-care for small-cell lung cancer, due to consistent findings of a reduced risk of developing brain metastases (BM) and a survival benefit. The role of PCI for patients with Non-small cell lung cancer (NSCLC) is less well established, since a clear survival benefit has not been identified, although high-risk subgroups have been identified, including patients with driver mutations and with elevated carcinoembryonic antigen (CEA) levels.
a9ded1e5ce5d75814730bb4caaf49419 Method
We assessed the use of PCI compared to observation in patients with stage IV NSCLC (NCT01603849). PCI dose was set 25 Gy/10 f. An amendment to the original record was requested so that patients who received PCI after January 2016 had hippocampal sparing. Primary end point was Intracranial Progression-Free survival (IPFS), secondary was overall survival (OS).
4c3880bb027f159e801041b1021e88e8 Result
84 patients were included, 43 were randomized to observation and 41 to PCI. 83.3% had a driver mutation (DM). Baseline characteristics were well balanced among groups. Median IPFS was 21.0 months (95%CI 16.2-25.9). Factors which were independently, positively associated with IPFS included ECOG (p=0.012) and therapeutic arm (p=0.006). PCI was associated with lower odds of progression to CNS (OR:0.16 (0.04–0.53), p=0.006).Cumulative incidence of BM at 1-yr was higher among patients without PCI (22% vs. 3%, p<0.001). Relative risk for IPFS in patients with DM was 0.29 (0.10-0.82, p=0.01), HR for OS was 0.48 (0.20-1.16, p=0.098). Median OS was higher in the PCI group compared to control [42.8 (95%CI: 28.1–57.6) vs. 25.9 (95%CI: 17.7 – 34.2)] months. Last, PCI was associated with lower hazards of death, 0.47 (0.24–0.95), p=0.035.
8eea62084ca7e541d918e823422bd82e Conclusion
PCI significantly increases IPFS and decreases risk of death in patients with advanced NSCLC, without neurocognitive impairment or decreased QoL. This intervention appears to be particularly useful for patients with good performance status and driver mutations. PCI increased IPFS without neurocognitive impairment or decreased QoL.
6f8b794f3246b0c1e1780bb4d4d5dc53Only 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.
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MA25 - Oligometastasis: Defining, Treating, and Evaluating (ID 929)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Oligometastatic NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 13:30 - 15:00, Room 203 BD
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MA25.10 - Complete Response by PET-CT After Radical Treatment in Oligometastatic Non-Small Cell Lung Cancer Predicts Longer Survival (ID 14232)
14:35 - 14:40 | Author(s): Monica Blake
- Abstract
- Presentation
Background
Evidence is rapidly accumulating for the use of radical treatment approaches for patients with oligometastatic Non-small cell lung cancer (NSCLC). Several limitations remain, however, to further strengthen the use of radical therapy as opposed to standard maintenance therapy, including a lack of robust markers to predict patient response. In this study, we assessed the utility of reaching a complete response (CR) by PET-CT in patients with oligometastatic disease after radical treatment (NCT02805530).
a9ded1e5ce5d75814730bb4caaf49419 Method
We included patients with stage IV NSCLC who presented with ≤5 synchronous, any-site metastases (oligometastatic disease) as assessed by PET-CT. Patients received 4 initial cycles of systemic treatment. Following, patients were evaluated by PET-CT and those with stable disease and partial response received radical treatment to the primary site and metastases (surgery, radiotherapy, chemotherapy plus radiotherapy, radiofrequency and SBRT alone or in any combination). Response to radical treatment was evaluated by PET-CT. Maintenance treatment was permitted.
4c3880bb027f159e801041b1021e88e8 Result
37 patients were included in the analysis. Mean age was 55.7. At diagnosis 43.2% of patients presented with CNS metastases. After 4 cycles of first-line therapy, 100% of patients received treatment to the primary site, while 83.8% also received therapy to metastases. Following radical treatment, 19 (51.4%) patients achieved a CR by PET-CT, while 18 (48.6%) had a partial response (NON-CR). Median PFS was 26.2 months (95%CI 12.2-40.1), and was positively affected by CR by PET-CT (NR vs. 14.3 [95%CI 11.9-16.7]; p<0.001). Median overall survival (OS) was NR. OS was also positively affected by CR by PET-CT (42-month survival: 82.5%±18 for CR vs. 34.4%±28 for NON-CR by PET-CT; p=0.01).
8eea62084ca7e541d918e823422bd82e Conclusion
Patients with oligometastatic NSCLC who undergo radical treatment and reach a CR by PET-CT show a significant improvement in survival outcomes. Our results suggest that CR by PET-CT could serve as a surrogate marker for prolonged survival in this patient su
6f8b794f3246b0c1e1780bb4d4d5dc53
bgroup.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.
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P2.06 - Mesothelioma (Not CME Accredited Session) (ID 955)
- 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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P2.06-02 - Feasibility of Intensity Modulated Radiotherapy After Pleurectomy/Decortication for Malignant Pleural Mesothelioma Patients (ID 12000)
16:45 - 18:00 | Author(s): Monica Blake
- Abstract
Background
Treatment strategies for patients with malignant pleural mesothelioma (MPM) include pneumectomy followed by radiation with considerable efficacy, although post-surgical morbidity and mortality are frequent. Recently, more conservative surgical approaches have been implemented, including Pleurectomy/Decortication (P/D), which spares the lung tissue while removing the malignant pleura and visible tumor. Although this approach significantly reduces surgical morbidity, it poses a challenge for post-surgical radiotherapy, as the risk of developing radiation pneumonitis is high. In this feasibility study we evaluated the loco-regional control and toxicity profile in patients with MPM treated with induction chemotherapy followed by P/C and Intensity Modulated Radiotherapy (IMRT) to the entire thoracic cavity.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients with MPM treated from October 2011 to February 2014 were screened for inclusion. All patients underwent 4 cycles of induction chemotherapy with cisplatin/gemcitabine or cisplatin/pemetrexed without progression followed by P/D. Thereafter, patients received IMRT to the thoracic cavity (50.4-54 Gy in 28-30 fractions), treated with 9-11 non-coplanar fields.
4c3880bb027f159e801041b1021e88e8 Result
A total of 20 patients were screened for inclusion, from these, 13 patients were included in the final analysis. The median age was 61.3 ±10.3 years; 69.2% (9/13) were classified as low risk according to the European Organization for Research and Treatment of Cancer prognostic group. From the 13 patients, 12 (92.3%) had a histological diagnosis of epithelioid mesothelioma, while one patient (7.7%) presented with a sarcomatoid histology. Partial response to chemotherapy was observed in 61.5% (8/13) and stable disease in 38.5% (5/13). After P/D, only 23% (3/13) had residual macroscopic disease. The median follow-up was 23.6 months (7.5-44.7). Nine patients had recurrence or progression (6 distant [67%] and 3 loco-regional recurrences [33%]). 2-year Progression Free Survival was 31.3% (95%CI [8.72-57.51]). Only one patient died due to hepatic metastases. Any grade Pneumonitis was reported in 69.2% (9/13), however only 22.2% (n=2) of patients presented grade ≥3 pneumonitis. The V5 of the contralateral lung was above 70% and the V20 of the total lung was 45% in these patients. No IMRT-related deaths were observed throughout the study.
8eea62084ca7e541d918e823422bd82e Conclusion
Results from this pilot study show that it is feasible to administer IMRT to patients who have undergone P/D while maintaining an adequate toxicity profile. In our study pulmonary toxicity was frequent; however there was only one event of grade 4 pneumonitis, meanwhile the loco-regional control using this treatment modality shows great promise. However, a larger study with a more robust sample size is required to draw strong conclusions.
6f8b794f3246b0c1e1780bb4d4d5dc53
