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Melissa Ana Liriano Vyfhuis



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    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
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      P1.01-10 - Stage III Non-Small Cell Lung Cancer Clinical Outcomes with Surgical Resection After Definitive Neoadjuvant Chemoradiotherapy (ID 14264)

      16:45 - 18:00  |  Author(s): Melissa Ana Liriano Vyfhuis

      • Abstract
      • Slides

      Background

      The role of neoadjuvant CRT followed by surgery (trimodality therapy) continues to evolve in patients with stage III non-small cell lung cancer (NSCLC). To date, limited prospective data exist assessing definitive preoperative radiotherapy doses. We report our clinical experience of high-dose (definitive) radiation-based trimodality therapy.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Between January 2000 and December 2016, 107 consecutive patients with stage III NSCLC treated with curative intent at our institution with definitive doses of neoadjuvant chemoradiotherapy (CRT) were analyzed. The primary endpoint was overall survival (OS) and secondary endpoint was freedom from recurrence (FFR), analyzed using the Kaplan-Meier method with log-rank testing. Cox regression with forward-model selection was used for the multivariate analyses (MVA).

      4c3880bb027f159e801041b1021e88e8 Result

      The patients had a median age of 58.5 years (range: 38-82) and were predominantly Caucasian (76%) with baseline performance status of 0 (69%). Stage grouping, according to the 7thedition of American Joint Committee on Cancer (AJCC) Lung Cancer Staging criteria, was IIIA: 78.5%, T3/4: 43.9%, N2: 74.8%, N3: 8.4%. CRT was delivered concurrently in 98% of the patients. Median radiation dose was 61.2Gy (range 39.6-69.6Gy); 89% receiving ≥60Gy. Radiation technique was (3D) conformal (71.0%) or intensity-modulated radiotherapy (IMRT) (27.1%). The 30-day and 90-day surgical mortality rates were 4.7% and 7.5%, respectively. At a median follow-up of 30 months (range: 3-186 months), estimated OS and FFR (median/5-year) were 61 months/ 49% and 29 months/ 35%, respectively. On univariate analysis (UVA), age ≥60 (HR, 1.776; 95% CI, 1.084–2.909; P=0.023) and having no health insurance (HR, 3.071; 95% CI, 1.060–8.902; P=0.039; as compared to those with private insurance) predicted for an increased risk of death, while receiving consolidation chemotherapy was associated with improved survival (HR, 0.472; 95% CI, 0.258–0.864; P=0.015). On MVA, age ≥60 was the only characteristic with a continued association with OS (HR, 1.779; 95% CI, 1.056–2.998; P=0.039). On UVA, lack of health insurance was the only predictor of disease recurrence (HR, 6.059; 95% CI, 2.244-16.360; P<0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      In a carefully selected population, full dose neoadjuvant CRT followed by surgery can achieve high OS and FFR even for stage III NSCLC patients, much higher than recent reports of bimodality therapy (RTOG 0617: median OS of 28.7 months and PACIFIC study: median PFS of 16.8 months). Prospective evaluation of high-dose radiation trimodality therapy versus induction chemotherapy alone is warranted.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P1.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 947)

    • 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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      P1.15-31 - Survival and Patterns of Care Comparing Black and White Patients With All Stages of NSCLC: An NCDB Analysis (ID 14084)

      16:45 - 18:00  |  Presenting Author(s): Melissa Ana Liriano Vyfhuis

      • Abstract
      • Slides

      Background

      Race and other socioeconomic factors continue to influence survival in patients with non-small cell lung cancer (NSCLC). Recent population-based studies have paradoxically shown a survival advantage in the black population compared to white patients with stage III NSCLC. To further investigate this, we analyzed stage-wise overall survival (OS) and patterns of care in black patients as compared to white patients with NSCLC using the National Cancer Database (NCDB).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      All black and white patients within the NCDB with biopsy-proven, stages I-IV NSCLC from 2004-2013 were analyzed. Associations between demographics was assessed using c2-tests. Guideline concordant care (GCC) and non-guideline concordant care (NGCC) were defined for each stage as per NCCN guidelines. OS between the races were analyzed using the log-rank test and the multivariable Cox proportional hazards regression.

      4c3880bb027f159e801041b1021e88e8 Result

      When compared to white patients, black patients were younger at presentation (</=60years: 36.2% vs. 22.5%, p<0.001), had a lower household income (<$30,000: 37.9% vs. 11.5%, p<0.001), twice as likely to not have insurance (6.4% vs. 2.9%, p<0.001) and were diagnosed with more advanced disease (stage I: 18% vs. 24.9%, stage II: 6.1% vs. 6.9%, stage III: 25.9% vs. 23.7%, stage IV: 50% vs. 44.5%, p<0.001).

      White patients were more likely to undergo GCC in stages I-III when compared to black patients (stage I: 77% vs. 69.6%; stage II: 68.5% vs. 65.3%; stage III: 52.8% vs. 51.9%) but had a very similar incidence of GCC in stage IV (stage IV: 66.7% vs. 67.3%, p<0.001).

      Black race was associated with a 17%, 5%, and 3% increase risk of NGCC in stage I (OR: 0.835, 95% CI: 0.817-0.852, p<0.001), stage II (OR: 0.947, 95% CI: 0.916-0.978, p=0.001) and stage III (OR: 0.970, 95% CI: 0.954-0.985, p<0.001) disease, respectively, when compared to white patients in multivariate analysis (MVA). While in stage IV, being black predicted for a 4% greater receipt of appropriate treatment (OR: 1.041, 95% CI: 1.028-1.054, p<0.001).

      In the Cox MVA, race was not linked to OS in stage I or II disease, but being black predicted for a 3% lower risk of death in stage III and IV (stage III: HR: 0.973, 95% CI: 0.965-0.982, p<0.001; stage IV: HR: 0.967, 95% CI: 0.961-0.973, p<0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Black patients with NSCLC had similar or slightly improved OS when compared to white patients after accounting for socioeconomic demographics, staging and patterns of care. To explain this contradictory finding, further research should investigate biological differences between the two races.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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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): Melissa Ana Liriano Vyfhuis

      • Abstract
      • Slides

      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.

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    P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)

    • 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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      P2.16-09 - Patterns of Brain Metastases in Stage I-III Non-Small Cell Lung Cancer: An NCDB Analysis (ID 13363)

      16:45 - 18:00  |  Author(s): Melissa Ana Liriano Vyfhuis

      • Abstract

      Background

      We have submitted single institution data suggesting nodal size is most associated with the development of brain metastases at diagnosis of non-small cell lung cancer, and seek to investigate the applicability of NCCN recommendations for brain magnetic resonance imaging (MRI) for non-small cell lung cancer (NSCLC) to evaluate rates brain metastases in patients with Stage I-III non-small cell lung cancer (NSCLC) in a population based cohort.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Results of patients diagnosed with NSCLC in the NCDB were evaluated between the years 2010 and 2013. Patients were included if they were AJCC 7th edition Stage I-III, or Stage IV patients on the basis of brain metastases alone. Exclusion criteria included those with bone, lung, or liver metastases at diagnosis. Due to heterogeneity in reporting in the NCDB, characterization of Stage IB, IIA, and IIB is difficult to discern. To account for this, we present rates of brain metastases for patients with T2N0, T1/2N1, and T3N0 disease within this cohort. Statistical evaluation included incidence of brain metastases per stage as well as logistic regression of baseline factors predictive of brain metastases (SPSS V21).

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 256,340 patients were included in the analysis. Overall rates of brain metastases were 6.4% (16,333/256,340). Brain metastases were identified in 1.6% (1457/89,868) of Stage IA patients, 5.5% (4038/73,233) of patients with Stage IB-II disease (4.6% (2025/44,026), 8.2% (1162/14,118), and 5.6% (851/15,089) for stages T2N0, T1/2 N1, and T3N0, respectively), 11.0% (6945/63,127) of Stage IIIA patients, and 12.9% (3893/30,112) of Stage IIIB patients. On multivariate analysis, younger age was associated with increased risk of brain metastases (p<0.01). When compared to Stage IIIB, patients with T1/2 N1 disease and Stage IIIA disease were most likely to have brain metastases (p<0.01 for both and HR 0.823 and 0.959, respectively). Poorly differentiated tumors were most associated with brain metastases (p<0.01 for both; HR 0.652 vs 0.187). Additionally, women were more likely to have brain metastases than men (p<0.01, HR 1.065). Adenocarcinoma histology was most likely to have brain metastases in our population (p<0.01, HR 1.162).

      8eea62084ca7e541d918e823422bd82e Conclusion

      This series shows that young age, adenocarcinoma histology, female gender, higher clinical stage disease, and younger age were associated with the development of brain metastases. Future analysis will be focused on developing a RPA classification of this data to further prognosticate most important features associated with the development of brain metastases in newly diagnosed NSCLC.

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