Author of

• 25917

  +

  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

  • 26198

    +

    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): Manuel Arguelles
    • Abstract
    • Presentation
    • Slides

    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 subgroup.

    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.

• 25921

  +

  P1.01 - Advanced NSCLC (Not CME Accredited Session) (ID 933)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall

  • 26230

    +

    P1.01-03 - Effect of Prophylactic Cranial Irradiation on Cognitive Function and QoL in NSCLC Patients at High Risk of Brain Metastases (ID 14166)

    16:45 - 18:00  |  Author(s): Manuel Arguelles
    • Abstract
    • Slides

    Background
    

    Up to 50% of NSCLC patients develop brain metastases (BM). Prophylactic Cranial Irradiation (PCI) is a potentially useful strategy to prevent this event, although its use remains controversial due to inherent risks. Therefore, actions such as dose adjustment for Whole Brain Radiotherapy (WBRT), or hippocampal-sparing techniques have been explored. We evaluated the impact of PCI on cognitive function and Quality of Life (QoL).

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    Within the clinical trial NCT01603849 we evaluated a total of 84 histologically-confirmed NSCLC patients with high risk of developing BM (adenocarcinomas harboring oncodrivers (EGFR or ALK) and/or carcinoembryonic antigen (CAE) level at diagnosis ≥20 pg/mL). Patients were randomized 1:1, 41 to receive PCI and 43 to observation. Cognitive function (CF) was evaluated before and after treatment and at 6, 9 and 12 months with Mini Mental State Examination (MMSE). Reliable Change Index was used to evaluate the effect on CF. QoL was assessed through the European Organization for Research and Treatment of Cancer (EORTC-QLQ-30). Differences between groups were compared with Mann Whitney U and Friedman test. OS was estimated from the first MRI assessing the absence of BM until death/last follow-up with Kaplan-Meier and compared with Log-Rank test.

    4c3880bb027f159e801041b1021e88e8 Result
    

    83.3% of patients presented an EGFR-mutation (n=60) or ALK-rearrangement (n=6). Median OS was 42.8 vs. 25.9 months among patients with or without PCI (p=0.031). MMSE scores and median score values for global QoL, fatigue and cognitive functioning did not differ among groups or at baseline and follow-up. There were also no differences in percentual change at 1-yr (Table).

    Clinical changes (MMSE)					3 months		6 months		9 months		1 yr
    					n/N (%)		n/N (%)		n/N (%)		n/N (%)
    Without PCI
    		Without Changes			38/43 (88.4)		34/42 (81)		34/42 (81.0)		29/37 (78.4)
    		Cognitive Deterioration			0/43 (0)		2/42 (4.8)		0/42 (0)		0/37(0)
    		Cognitive Improvement			5/43 (11.6)		6/42 (14.2)		8/42 (19.0)		8/37 (21.6)
    With PCI
    		Without Changes			39/41 (95.1)		31/34 (91.2)		31/34 (91.2)		27/31(87.1)
    		Cognitive Deterioration			1/41 (2.4)		0/34 (0)		0/34 (0)		1/31(3.2)
    		Cognitive Improvement			1/41 (2.4)		3/34 (8.8)		3/34 (8.8)		3/31 (9.7)
    			Baseline		3 months	6 months		9 months		1 yr		p-Value (*)	Diff. at 1 yr
    			Median (IQR)		Median (IQR)	Median (IQR)		Median (IQR)		Median (IQR)			Median (IQR)
    Global QoL	Without PCI		66.7 (50.0 - 83.3)		66.7 (50.0 - 83.3)	66.7 (64.6 - 83.3)		83.3 (66.7 - 85.4)		83.3 (75.0 - 87.5)		<0.001	8.3 (0.0 - 29-2)
    	With PCI		66.7 (50.0 - 83.3)		66.7 (50.0 - 83.3)	66.6 (66.7 - 83.3)		83.3 (66.7 - 83.3)		83.3 (75.0 - 83.3)		<0.001	0.0 (0 - 25.0)
    p-Value (diff between groups)				0.956	0.786	0.903		0.172		0.595			0.791
    Fatigue	Without PCI		22.2 (11.1 - 44.4)		33.3 (22.2 - 44.4)	22.2 (11.1 - 44.4)		22.2 (11.1 - 44.4)		22.2 (11.1 - 33.3)		<0.001	0.0 (-22.2 - 0.0)
    	With PCI		22.2 (5.6 -33.3)		33.3 (11.1 - 33.3)	22.2 (8.3 - 33.3)		22.2 (8.3 - 33.3)		22.2 (0.0 - 33.3)		<0.001	0 (0 - 0)
    p-Value (diff between groups)				0.493	0.132	0.942		0.931		0.93			0.553
    Cognitive	Without PCI		83.3 (66.7 - 100.0)		83.3 (66.7 - 100.0)	83.3 (66.7 - 100.0)		73.3 (83.3 - 100.0)		73.3 (83.3 - 100.0)		0.004	0 (0 - 0)
    	With PCI		83.3 (66.7 - 100.0)		83.3 (66.7 - 100.0)	83.3 (66.7 - 100.0)		91.7 (70.8 - 100.0)		83.3 (83.3 - 100.0)		0.017	0.0 (0.0 - 0.0)
    p-Value (diff between groups)				0.854	0.983	0.521		0.411		0.757			0.734

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    PCI was not associated with significant differences in MMSE and QoL scores, furthermore there were no differences when assessing specific subscales (e.g. fatigue and cognitive functioning). These results along with the clinical benefit in OS highlight the benefit of this approach particularly among patients at high risk of developing BM.

    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.