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Yanyan Lou
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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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P1.01-17 - Immune-Related Adverse Events in Patients with Metastatic Non-Small Cell Lung Cancer: Sex Differences and Response to Therapy. (ID 12642)
16:45 - 18:00 | Author(s): Yanyan Lou
- Abstract
Background
Sex differences in non-small cell lung cancer (NSCLC) outcomes have been described. Immune-related adverse events (IRAEs) have emerged as a serious clinical problem in the use of immune checkpoint inhibitors (ICI). Risk factors for IRAEs and their association with response to therapy remain controversial. Therefore, we studied sex differences in IRAEs and their association with response to therapy.
a9ded1e5ce5d75814730bb4caaf49419 Method
All patients with metastatic NSCLC treated with anti-PD1 and anti-PDL1 therapy at Mayo Clinic Rochester and Florida from 2015 to 2018 were reviewed. Patients receiving treatment at an outside facility or with history autoimmune disorders were excluded. Kaplan-Meier method was used for time-to-event analysis.
4c3880bb027f159e801041b1021e88e8 Result
231 patients were identified, 120 (52%) were women and 111 (48%) were men. Baseline characteristics and ICI distribution were similar among groups (Table 1). Women were more likely to experience IRAEs compared to men (48% vs. 31%, p<0.008). Among patients with IRAEs, women were more likely to be prescribed systemic steroids (63% vs. 41%, p<0.02). Women were more likely to develop pneumonitis (23% vs. 12%, p<0.03) and arthralgia (17% vs. 3%, p<0.04). However, dermatologic toxicities (35% vs. 9%, p<0.002) were more commonly seen in men. In 17% of women the ICI was discontinued due to toxicity (men 7%). Besides sex, no other clinical characteristic was associated with increased IRAEs. Women with IRAEs were more likely to have a radiographic response compared with women without IRAEs (78% vs. 23%, p<0.0001), although this was not observed in men (37% vs. 26%, p>0.22). Better PFS was observed in women with IRAEs (10 months vs. 3.3 months, p<0.0006) compared to women without IRAEs.
Women % (n)
Men % (n)
p value
PD-L1 expression ≥1%
30 (36)
34 (38)
0.29
Adenocarcinoma
77 (92)
66 (73)
0.02
Bone metastasis
34 (41)
47 (52)
0.05
Brain metastasis
20 (24)
22 (24)
0.76
Liver metastasis
13 (15)
10 (11)
0.53
Prior chemotherapy
74 (89)
85 (94)
0.06
Prior palliative radiation
53 (63)
57 (63)
0.52
IRAEs
48 (57)
31 (34)
0.006
≥3 grade IRAEs
42 (24)
29 (10)
0.22
Received systemic steroids
63 (36)
41 (14)
0.02
Required intravenous steroids
30 (17)
24 (8)
0.47
8eea62084ca7e541d918e823422bd82e Conclusion
Women with metastatic NSCLC are more likely to experience IRAEs compared to men. In women, an association between IRAEs and response to therapy was observed. Larger studies are needed to investigate the mechanisms underlying these associations.
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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P1.15-18 - The Impact of Patient Age on Clinical Outcomes in NSCLC: A National Study (ID 14182)
16:45 - 18:00 | Presenting Author(s): Yanyan Lou
- Abstract
Background
Treatment of NSCLC is rapidly advancing. Clinical outcomes and treatment modalities for patients in each age group remain unknown. This study investigates the treatment modalities in each age group and the impact of patients’ age on survival.
a9ded1e5ce5d75814730bb4caaf49419 Method
The National Cancer Database with NSCLC between 2004-2014 was used. Overall survival (OS) and treatments were analyzed by age groups, accounting for multivariates.
4c3880bb027f159e801041b1021e88e8 Result
A total of 2,327,158 NSCLC patients were included. Median OS is 114.6, 76.7, 52.6 and 33 months for stage I lung cancer patients at age <60, 60-69, 70-79 and ≥ 80 respectively (p<0.0001). Median OS is 7, 5.9, 4.6 and 3.3 months for stage IV patients at age <60, 60-69, 70-79 and ≥ 80 respectively (p<0.0001). The impact of age on survival is cross all stages. Younger patients are associated with larger tumor size and higher percentage of stage V at time of diagnosis. Patients with age ≥ 80 are associated with high income, high education and pacific region. Despite comparable comorbidity, patients with age ≥ 80 are treated differently and received much less aggressive therapy at each stage (p<0.0001).
8eea62084ca7e541d918e823422bd82e Conclusion
The overall survival of NSCLC is significantly impacted by patient’s age. Under-treatment in elderly patients might contribute to poor survival.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.06 - Mesothelioma (Not CME Accredited Session) (ID 955)
- 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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P2.06-24 - The Impact of Demographic and Socioeconomic Factors on Survival of Patients with Mesothelioma in the USA (ID 14073)
16:45 - 18:00 | Author(s): Yanyan Lou
- Abstract
Background
Malignant Pleural mesothelioma (MPL) is a rare cancer with about 3000 new cases diagnosed each year in the USA. It has poor prognosis with 5 year survival rate of 10%. We performed a national study to assess the impact of demographic and socioeconomic factors on survival of patients with MPL.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients with MPL diagnosed between 2004-2014 were identified from the National Cancer Database (NCDB). Demographic and socioeconomic factors were collected. The impact on survival was evaluated with Cox regression model after adjusting for the variables.
4c3880bb027f159e801041b1021e88e8 Result
Total of 24826 patients with MPL were included. Median age at diagnosis was 73. Majority of patients were men (75 %), white (93%), insured (97%), lived in a metro area (84%) and treated at an academic facility (64%). Most patients lived in either eastern or central geographic location (45% and 39% respectively). Median overall survival (OS) was 9.8 months. Women had significantly better OS (12.4 months) vs men (9.3 months). (Table 1) OS was better with younger age (16.6 months for patients < 60; 12.4 months for 60-69; 9.9 months for 70-79 and 5.6 months for ≥ 80). Other factors associated with better OS included early stage, lower comorbidity, higher income and treatment at an academic facility. Neither insurance status nor education level had any impact on OS. Race did not impact survival except for Native Americans and Alaskans (represented only 0.2 % of patients) who had better OS compared to Whites.
8eea62084ca7e541d918e823422bd82e Conclusion
In this largest analysis exploring socio-demographic factors affecting MPL outcomes, we note some disparities. While some of these factors are non-modifiable, others including access to healthcare, income and treating facility type are modifiable. These must be addressed to minimize disparities in outcomes and realize maximal benefit for patients with this incurable malignancy.
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