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Shahed Badiyan



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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): Shahed Badiyan

      • 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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    P1.17 - 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
    • +

      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): Shahed Badiyan

      • 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.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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