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Martin J. Edelman
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MA18 - Modelling, Decision-Making and Population-Based Outcomes (ID 920)
- 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, 13:30 - 15:00, Room 201 F
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MA18.10 - Evolving Immunotherapy Practice Patterns in Advanced NSCLC: Analysis of an Online Treatment Decision Tool (ID 13848)
14:30 - 14:35 | Author(s): Martin J. Edelman
- Abstract
- Presentation
Background
Checkpoint immunotherapy (IO) is revolutionizing NSCLC therapy. We have previously published results of an online decision support tool designed to provide clinicians with education and expert guidance (Chow et al: JTO 2015). Here we report an analysis of a recently updated version of this online tool, capturing the impact of emerging IO options.
a9ded1e5ce5d75814730bb4caaf49419 Method
From June 2016 to July 2017, the NSCLC decision tool was updated to incorporate new treatment options for 280 different case scenarios. Briefly, oncologists entered patient and disease characteristics and then their planned treatment into the tool. Afterwards recommendations from 5 lung cancer experts were provided for that specific patient scenario.
4c3880bb027f159e801041b1021e88e8 Result
This analysis includes 1481 individual cases entered by 863 practicing oncologists between June 2016 and April 2018 (USA 19%, Europe 33%, Rest of World 48%). During this time, treatment choices for EGFR and ALK cancers by oncologists closely resemble those of experts. After approval of 1st-line pembrolizumab for patients with high PD-L1 expression, oncologists recommended pembrolizumab less often than experts (67% vs 95%). In the 2nd-line setting following platinum chemotherapy, both tumor histology and PD-L1 expression level impacted treatment recommendations (see Table). For PD-L1 expression < 1%, recommendations between oncologists and experts differed substantially.
Second-line setting after platinum chemotherapy Participants' Treatment Choice Experts' Treatment Choice 2016 2017 2016 2017 Nonsquamous PD-L1 (≥ 1%) 54% IO
34% CT
(n = 35)
79% IO
15% CT
(n = 47)100% IO
85% IO
15% CT
PD-L1 (< 1%) 28% IO
65% CT
(n = 104)49% IO
41% CT
(n = 63)40% IO
55% CT
75% IO
25% CT
Squamous PD-L1 (≥ 1%) 62% IO
25% CT
(n = 24)74% IO
4% CT
(n = 23)100% IO
100% IO
PD-L1 (< 1%) 28% IO
65% CT
(n = 74)
38% IO
40% CT
(n = 45)
85% IO
15% CT
80% IO
20% CT
8eea62084ca7e541d918e823422bd82e Conclusion
This updated analysis of an online NSCLC decision-making tool integrates recent changes to the treatment landscape in 2017, capturing emerging patterns in IO therapy. Compared to earlier versions, practicing oncologist’s choice of 1st-line EGFR- and ALK- targeted therapy more closely tracked with experts during this period, while selection of IO differs from expert recommendations. A detailed analysis of expert versus online user data will be presented.
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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OA05 - Clinical Trials in IO (ID 899)
- Event: WCLC 2018
- Type: Oral Abstract Session
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 13:30 - 15:00, Room 106
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OA05.04 - Discussant - OA 05.01, OA 05.02, OA 05.03 (ID 14554)
14:00 - 14:15 | Author(s): Martin J. Edelman
- Abstract
Abstract not provided
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P1.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 949)
- 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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P1.17-10 - Consolidation Chemotherapy in Stage III Non-Small Cell Lung Cancer: Still a Critical Piece of the Puzzle (ID 14262)
16:45 - 18:00 | Author(s): Martin J. Edelman
- Abstract
Background
Despite lack of proven survival benefit, national guidelines recommend that patients with stage III non-small cell lung cancer (NSCLC) treated with chemoradiation (CRT) using weekly regimens receive two additional cycles of full dose consolidation chemotherapy (cCT). We seek to explore the benefit of cCT in our mature annotated cohort of stage III NSCLC patients treated with modern radiation therapy (RT) and predominantly weekly carboplatin/paclitaxel-based CRT.
a9ded1e5ce5d75814730bb4caaf49419 Method
In this retrospective analysis, 355 consecutive patients with stage III NSCLC treated with either definitive CRT alone (bimodality) or followed by surgery (trimodality), between the years 2000-2013 were analyzed. Median age of the patients was 60 years (range: 30-86). Stage grouping was IIIA: 56.3%, T3/4: 49%, N2: 61.4%; N3: 21.4%. Histology was evenly distributed between squamous, adenocarcinoma, other or not specified. Concurrent CRT was delivered in 92.1% of the patients, 74% receiving weekly carboplatin/paclitaxel. Median radiation dose was 63Gy (range 10.8-81.6Gy). Data on cCT use was available in 304 patients, 69.7% receiving cCT. Logistic regression was performed to assess predictors for the use of cCT. Kaplan-Meier method and Cox proportional hazards model was used to estimate the overall (OS) and freedom-from-recurrence (FFR) adjusted for age, gender, marital status, insurance status, smoking history, COPD diagnosis, performance status, Charlson score, year of diagnosis, concurrent vs sequential CRT, RT technique, RT dose and surgery.
4c3880bb027f159e801041b1021e88e8 Result
With a median follow up of 15 months (range: 1-184 months), OS (median/5-year) with and without cCT was 30.2 months/ 30.5% and 15.3 months/ 12.9%, respectively (multivariate adjusted HR for death: 0.50; 95% CI: 0.37-0.69, p < 0.001). Corresponding values for FFR were 19 months/ 27% and 11.2 months/ 11.4% (adjusted HR: 0.54; 95% CI: 0.37-0.77, p = 0.001).
On subset analysis, the OS benefit was seen in patients undergoing bimodality therapy (HR: 0.57; 95% CI: 0.40-0.83, p = 0.003) but not for trimodality therapy (p = 0.124). Similarly, an OS benefit was seen in stage IIIA (HR: 0.35; 95% CI: 0.23-0.55, p < 0.001) but not for stage IIIB patients (p = 0.071). The only factor predicting the use of cCT was primary treatment: bimodality vs trimodality (OR: 2.2; 95% CI: 1.1-4.3, p = 0.018 favoring bimodality).
8eea62084ca7e541d918e823422bd82e Conclusion
Consolidation chemotherapy should continue to be strongly considered for stage III NSCLC patients, especially those undergoing bimodality therapy receiving weekly sensitizing doses of carboplatin-paclitaxel and with stage IIIA disease. The relative benefit of cCT in the setting of maintenance durvalumab (or other immunotherapy) needs further evaluation.
6f8b794f3246b0c1e1780bb4d4d5dc53
