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Olivier Bylicki



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    MA14 - Survivorship, Socioeconomic and End-of-Life Considerations (ID 915)

    • 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, 10:30 - 12:00, Room 205 BD
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      MA14.03 - Aggressiveness of Cares on the Month Before Death of Patients with Lung Cancer: A French National Database Survey (ID 12005)

      10:40 - 10:45  |  Presenting Author(s): Olivier Bylicki

      • Abstract
      • Presentation
      • Slides

      Background

      Prior studies have demonstrated that high-intensity end of life (EOL) cares improves neither survival nor quality of life for cancer patients. The National Quality Forum endorses markers of poor EOL care for cancer patients but there is little data’s concerning lung cancer patients (1). The aim of this study was to assess, the quality of management during the last month of life of lung cancer patients managed in France and factors associated EOL aggressiveness.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Using a French hospital discharge database (PMSI, Programme de Médicalisation des Systèmes d’Information), all patients with lung cancer who died between January 1, 2010 and December 31, 2011 (cohort 1) and between January 1, 2015 and December 31, 2016 (cohort 2) were identified through the International Classification of Diseases 10th version (ICD-10). Aggressiveness of EOL cares was assessed by the following criteria’s 1) chemotherapy administrated within last 14 days of life (DOL); 2) > 1 hospitalization within 30 DOL; 3) ICU admission within 30 DOL; and 4) Palliative care < 3 days before death. Multivariate analysis was performed to identify individual determinants EOL aggressiveness.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 90,827 incident adult patients were identified (cohort 1: 43,862, cohort 2: 46,965): men: 74%, median age: 67 years], metastatic at diagnosis: 70%; 57% have at least one marker of aggressiveness of EOL cares (repeated hospitalizations: 49%, ICU admissions: 12%, chemotherapy within 14 DOL: 9%, palliative care < 3 days before death: 5%). A significant increase was observed between 2010/2011 and 2015/2016 for repeated hospitalizations (48% vs 51%, p<.001) and ICU admissions (11% vs 13%, p<.001); the two other markers have remained stable. In multivariate analysis of cohort 2, the risk of aggressiveness of care in EOL was increased by the presence of COPD (OR: 1.08, 95%CI: 1.02-1.14) and a management in an anti-cancer center (OR: 2.32,95%CI 2.05-2.61) while advanced age (OR: 0.51, 95%CI 0.47-0.55), female sex (OR: 0.86 95%CI: 0.82-0.90), malnutrition (OR: 0.72, 95%CI:0.68-0.76) were protective factors for EOL aggressiveness of cares.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Despite growing focus on providing appropriate EOL cares, in this analysis 57% of deceased lung cancer patients in France received aggressive EOL cares. Research must be undertaken to better identify patients at risk of aggressive EOL cares and to improve the quality of cares of last days of life these patients.

      1.McNiff KK, . Measuring supportive care in medical oncology practice: lessons learned from the quality oncology practice initiative. JCO 2008;

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    P1.04 - Immunooncology (Not CME Accredited Session) (ID 936)

    • 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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      P1.04-31 - Efficacy and Tolerance of Immune-Checkpoint Inhibitors in EGFR, ALK/ROS 1 Non-Small-Cell-Lung-Cancer (NSCLC): GFPC 03-2016 IMAD Study (ID 11166)

      16:45 - 18:00  |  Presenting Author(s): Olivier Bylicki

      • Abstract
      • Slides

      Background

      Patients with molecular alterations are considered to be poor candidates for immune- checkpoint inhibitors (ICI) on the second-line phase III trials. Here, we analyze the efficacy of ICI in EGFR /ALK/ROS1 NSCLC patients in real world setting

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This retrospective, multicentric study in EGFR, ALK and ROS1 NSCLC treated by ICI, analyzed clinical characteristics and outcomes (progression free survival (PFS), duration of ICI treatment and overall survival (OS), since initiation of ICI .

      4c3880bb027f159e801041b1021e88e8 Result

      51 patients were included from 20 centers in France: 100% adenocarcinoma, 60.7% never smokers, 58.8% female, 58 ± 8.8 years age at diagnosis (36-83), 82.3% EGFR mutated, 15.7 % and 2% ALK and ROS 1 translocated respectively. ICI was a third line treatment in 35,3% of cases, a fourth and more lines treatment in 64,7% of cases. Median PFS was 2.1. [95% CI: 1.5-3.2] months for the whole population, 2.15 [95% CI: 1.4-3;2], for EGFR patients and 2.4 [95% CI: 2.1; NR] for ALK tranlocated patients; 3 months-PFS were 37,3% [95% CI: 26.1; 53.2]; 8 weeks ORR were 19.6% (10 pts with partial response). The median OS for the whole population was 14.7.[95%CI: 12.1-19.2] months, 13.9 [95% CI: 8.8-20] for EGFR patients, 19.2. [95% CI: 13.1-NR] for ALK translocated; 7 (13.7%) patients were treated more than 9 months by ICI; 21.6% (11/51) of patients reported toxicities, all < grade3.

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      8eea62084ca7e541d918e823422bd82e Conclusion

      In this real-world setting analysis, efficacy of ICI in EGFR, ALK, ROS1 NSCLC patients appears close to the efficacy observed in pretreated unselected NSCLC patients. Large prospective studies are needed in these populations

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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: 2
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.15-04 - Costs of Cares on the Month Before Death of Patients with Lung Cancer: A French National Database Survey (ID 12006)

      16:45 - 18:00  |  Presenting Author(s): Olivier Bylicki

      • Abstract
      • Slides

      Background

      There is a few data’s on the burden of the last month of life of patient with lung cancer and on impact of end of life (EOL) aggressiveness of cares. The aim of this study was to assess the costs of the month before death in patients with lung cancer and the impact of aggressiveness of cares during this period.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Using a French hospital discharge database (PMSI, Programme de Médicalisation des Systèmes d’Information), all adult patients with lung cancer who death between January 1, 2010 and December 31, 2011 (cohort 1) and between January 1, 2015 and December 31, 2016 (cohort 2) were identified through the International Classification of Diseases 10th version (ICD-10). Aggressiveness of EOL cares was assessed by the following criteria’s 1) chemotherapy administrated within last 14 days of life (DOL); 2) > 1 hospitalizations within 30 DOL; 3) ICU admission within 30 DOL; and 4) palliative care < 3 days before death.Direct hospital costs were assessed from the French public health insurer perspective based on DRG tariffs. Costs were expressed in 2017 Euros.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 90,827 i patients were identified: men: 74%, median age: 67 years [59-77], metastatic at diagnosis: 70%;57% have at least one marker of aggressiveness of EOL cares (repeated hospitalization: 49%, ICU admissions: 12%, chemotherapy within 14 DOL: 9%, and palliative care < 3 days before death: 5%). The mean cost of last month of EOL was € 8,152 ± 5,117 (346 - 91,537) per patient, significantly more important in patients with at least one aggressiveness marker of EOL cares (€ 9,480±5,946 vs € 6,376±2,898, p <0.001). These over-costs were explained in large part by hospitalizations and intensives cares costs (€ 8,080 ± 4,296 vs € 6,228 ±2,752 and € 1,063 ± 2,948 vs € 92 ± 546). The cost of expensive drugs (€ 285 ± 888 vs € 39 ± 330), radiotherapy (€ 14 ± 138 vs € 6 ± 84) and medical devices (€ 38 ± 352 vs € 11 ± 137) does not impact the extra costs of patients with markers of aggressiveness of cares.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The EOL economic burden is major for the healthcare system, with extra costs of more than € 3,000 per patient in case of EOL aggressiveness markers. Organizing a precocious palliative care system may improve the quality of cares of EOL and reduce the financial costs of the last days of life of lung cancers patients.

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      P2.15-29 - Eligibility for Anti-Angiogenic Treatments in Patients with Squamous Non-Small Cell Lung Cancer (SQ-NSCLC): EPISQUAMAB Study (GFPC 2015-01) (ID 11338)

      16:45 - 18:00  |  Author(s): Olivier Bylicki

      • Abstract
      • Slides

      Background

      Antiangiogenic treatments are today restricted to non-squamous NSCLC. New drugs, like ramucirumab, have been approved in second line setting for advanced NSCLC regardless histology but there is little information about the rate of squamous NSLC eligible to these treatments. This descriptive, prospective, observational study aimed to assess the rate of squamous advanced NSCLC patients eligible to anti-angiogenic treatments.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Each participating center had to include consecutive relapsed advanced SQ-NSCLC and to assess the presence of common criteria which restricted the use of antiangiogenic treatments (hemoptysis, cardiovascular diseases, tumoral extension to blood vessels and tumoral cavitation).

      4c3880bb027f159e801041b1021e88e8 Result

      From july 2016 to july 2017, 317 patients were included: 256 (80.8%) men, PS0/1/2 in 30.5%/54.5%/14.9% patients, stage IV in 74.5% of cases. Ineligibility criteria for anti-angiogenic therapy were found in 53.6% of patients (one single criteria in 29,3%, two criteria in 19,9%, three in 3.5%). The main reasons for ineligibility was as followed: blood vessel extension 39.8%, cavitation 20.5%, hemoptysis 7.2%, cardiovascular diseases 12.1%.

      Table described patients characteristics according to the ineligibility criteria: Cavitation had the highest number of metastatic disease, cardiovascular diseases the highest number of men and number of metastatic site.

      table.jpg

      8eea62084ca7e541d918e823422bd82e Conclusion

      In a non-selected advanced SQ-NSCLC population, only half of these patients are ineligible to a second line anti-angiogenic treatments with a wide majority of tumoral blood vessel extensions and cavitations.

      _______________________________________________________________________________________________________________

      In collaboration with the GFPC* team and supported by an academic grant from Lilly pharmaceuticals.

      *GFPC: French Lung Cancer Group

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