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Shantanu Banerji



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    P1.12 - Small Cell Lung Cancer/NET (Not CME Accredited Session) (ID 944)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.12-08 - The Effect of Cisplatin Versus Carboplatin on Cancer Outcomes for Small Cell Lung Cancer Patients in a Population-Based Cohort (ID 14373)

      16:45 - 18:00  |  Author(s): Shantanu Banerji

      • Abstract
      • Slides

      Background

      Small cell lung cancer (SCLC) is associated with high rates of mortality and treatment involves chemotherapy. In non-small cell lung cancer, using cisplatin results in superior response and survival compared to carboplatin, but causes more toxicity. Little research regarding this drug choice in SCLC exists, but available studies suggest equivalent survival. Nevertheless, many oncologists continue to use cisplatin preferentially.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Using the population-based Manitoba Cancer Registry, we identified SCLC cases diagnosed from 2004 to 2013 in Manitoba and completed a retrospective chart review for those treated with chemotherapy. Demographics, tumour response, and treatment toxicity were compared between cisplatin and carboplatin treated groups. Overall survival (OS) and progression free survival (PFS) were evaluated using multivariate Cox proportional hazard methods. Likelihood of completing chemotherapy (at least 4 cycles) was assessed using multivariable logistic regression.

      4c3880bb027f159e801041b1021e88e8 Result

      Of the 531 patients identified, 139 (26.2%) received carboplatin and 392 (73.8%) received cisplatin as part of first line chemotherapy. More patients who received carboplatin had poor performance status (13.7% v 7.4%), elevated LDH (58.3% v 42.3%), and extensive stage disease (69.8% v 54.1%), all p<0.01. Unadjusted median OS was 224 v 322 days for carboplatin and cisplatin. Multivariable adjusted analysis for OS using cisplatin patients not completing treatment as the reference comparator showed hazard ratios for carboplatin completers – 0.65 (0.43-0.98), cisplatin completers – 0.69 (0.47-1.00), and carboplatin incompleters – 1.00 (0.64-1.55), p = 0.13. For PFS carboplatin completers – 1.07 (0.60-1.90), cisplatin completers – 0.83 (0.51-1.36), and carboplatin incompleters – 0.96 (0.64-1.46), p = 0.59. There was not significant difference between carboplatin and cisplatin in likelihood of completing chemotherapy, when adjusted for other patient characteristics - 0.75 (0.47-1.22), p=0.26 Those treated with carboplatin had significantly less neutropenia (57.6% v 74.7%), nephrotoxicity (2.9% v 13.5%), neurotoxicity (0.7% v 12.0%), and nausea/vomiting (28.1% v 42.6%) associated with treatment, all p<0.01.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In a real world, population-based setting, carboplatin appears to be an equally effective treatment option for SCLC, facilitating equivalent survival while avoiding toxicity. Clinicians may wish to re-examine their preference for cisplatin.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      P1.12-09 - The Effect of Site of First Chemotherapy on Small Cell Lung Cancer Patient Outcomes (ID 13082)

      16:45 - 18:00  |  Author(s): Shantanu Banerji

      • Abstract
      • Slides

      Background

      Small cell lung cancer (SCLC) ischaracterized by a rapid doubling time and high responsiveness to chemotherapy (CT) with a rapid relapse. Due to the sensitivity of SCLC to CT, it is one of the few malignancies treated in acutely ill patients admitted to hospital with a poor performance status (PS). However, there is little available information on the outcomes and toxicity experienced by patients with SCLC who require initial CT as an inpatient.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A retrospective cohort study was conducted evaluating patients consecutively diagnosed with SCLC in Manitoba from 2004 to 2013 treated with platinum-doublet CT. Patient demographics, staging, treatment, CT toxicities, Eastern Cooperative Oncology Group(ECOG) PS, treatment response, and survival were collected using the Manitoba Cancer Registry and chart review. Outcomes of progression free survival (PFS) and overall survival (OS) were evaluated based on site of first CT (inpatient versus outpatient) and PS.

      4c3880bb027f159e801041b1021e88e8 Result

      530 patients received CT for SCLC with 82 patients (15%) receiving their first CT as an inpatient. Sixty-three percent of inpatients received the full CT course, compared to 81% of outpatients, (p=0.0006). Outpatients had a greater likelihood of responding to CT (p=0.0043). Neutropenia, febrile neutropenia, thrombocytopenia, nephrotoxicity and fatigue were all experienced less often by the inpatient cohort, (p<0.0001), (p=0.0040), (p<0.0001), (p<0.0001) and (0.0068). For inpatients, OS at 12, 24 and 60 months was 22%, 9% and 7%, versus outpatient OS of 43%, 20% and 9%, (each p<0.0001). Median PFS and OS were longer for outpatients, 212 versus 161 days, (p=0.0035) and 321 versus 192 days, (p=0.0003). Patients with poorer ECOG PS had shorter PFS and OS; with a median PFS for PS 0, 1-2, 3-4 of 316, 203 and 147 days, (p<0.0001) and median OS for PS 0, 1-2 and 3-4 of 498, 303 and 179 days, (p<0.0001). On multivariate analysis, ECOG PS was an independent predictor of outcome, (p=0.0005) while site of first CT was not significant when ECOG PS was included, (p=0.3494).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Although SCLC patients initially treated as inpatients had shorter PFS and OS, some experienced long term survival, including a 7% five-year survival. CT toxicities were not more common for inpatients. This validates that administration of CT in hospital can be considered as these patients may have a meaningful long-term response to therapy if properly selected. As previously identified in the literature, this data demonstrated that patients with poorer ECOG PS have shorter PFS and OS.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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