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Simon Martel



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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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      P1.15-13 - Wait Times for Diagnosis and Treatment of Lung Cancer Across the Province of Quebec, Canada (ID 13472)

      16:45 - 18:00  |  Author(s): Simon Martel

      • Abstract
      • Slides

      Background

      Multiple clinical practice guidelines recommend rapid evaluation of patients with suspected lung cancer. Diagnostic pathways and wait times vary considerably from one centre to another.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively reviewed medical records of all patients (n=1217) across the province of Quebec who had a biopsy-proven diagnosis of lung cancer between February 1st and April 30th, 2017. Median wait times for diagnosis and treatment were calculated.

      4c3880bb027f159e801041b1021e88e8 Result

      Patient characteristics are shown in Table 1. Median wait times for investigation and treatment are shown in Table 2. There were variations between centres and regions.

      Characteristic

      No (%)

      Age, years, mean (range)

      68.5 (20-94)

      Male sex

      585 (48)

      Smoking status

      Former or current smoker

      Never smoker

      Unknown

      1120 (92)

      60 (5)

      37 (3)

      ECOG performance status

      0

      1

      ≥2

      Missing

      416 (34)

      358 (30)

      393 (32)

      50 (4)

      Histology

      Adenocarcinoma

      631 (52)

      Squamous cell carcinoma

      284 (23)

      NSCLC NOS

      70 (6)

      SCLC

      178 (15)

      Other

      54 (4)

      TNM stage

      I

      213 (18)

      II

      114 (9)

      III

      227 (19)

      IV

      475 (39)

      Limited SCLC

      40 (3)

      Extensive SCLC

      138 (11)

      Missing

      10 (1)

      Known positive EGFR mutation status (n=395 tested)

      Known positive ALK translocation status (n=387 tested)

      PD-L1 TPS (n=386 tested)

      <1%

      1-49%

      ≥50%

      Number of investigations per patient, median (IQR)

      28 (7)

      6 (2)

      85 (22)

      151 (39)

      150 (39)

      7 (6, 8)

      Tumor board review

      194 (16)

      Final diagnostic procedure

      Flexible bronchoscopy

      338 (28)

      EBUS/EUS

      223 (18)

      Transthoracic needle biopsy

      301 (25)

      Thoracoscopy

      139 (11)

      Biopsy of metastatic site

      145 (12)

      Sputum cytology

      1 (0)

      Thoracentesis

      61 (5)

      Mediastinoscopy

      Missing

      2 (0)

      7 (1)

      ECOG = Eastern Cooperative Oncology Group; NSCLC = non-small cell lung cancer; NOS = not otherwise specified; SCLC = small cell lung cancer; EGFR = epidermal growth factor receptor; ALK = anaplastic lymphoma kinase; TPS = tumor proportion score; IQR = interquartile range; EBUS = endobronchial ultrasonography; EUS = endoscopic ultrasonography.

      Table 2 – Median wait times for investigation and treatment

      Investigation or treatment interval

      Pts (n)

      Median wait, days (IQR)

      Referral to first appointment with specialist

      972

      2 (0, 7)

      First appointment to diagnosis

      1152

      18 (8, 43)

      Diagnosis to first treatment

      930

      22 (5, 42)

      Referral to first treatment

      737

      58 (28, 89)

      Abnormal imaging to first treatment

      902

      72 (39, 111)

      Surgery

      268

      109 (80, 142)

      Radiation

      362

      59 (28, 98)

      Systemic therapy

      330

      62 (35, 92)

      8eea62084ca7e541d918e823422bd82e Conclusion

      To our knowledge, this is the largest multicentre review of wait times for diagnosis and treatment of lung cancer with detailed characteristics of patients. Data will be completed and updated prior to the meeting, to try to identify specific factors associated with longer wait times.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.11 - Screening and Early Detection (Not CME Accredited Session) (ID 960)

    • 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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      P2.11-23 - Risk Perception Among a Lung Cancer Screening Population (ID 13045)

      16:45 - 18:00  |  Author(s): Simon Martel

      • Abstract
      • Slides

      Background

      To make lung cancer screening feasible, populations with the highest risk of developing cancer need to be targeted. Furthermore, factors which motivate individuals to participate in lung cancer screening programs should be integrated into recruitment strategies. Among these motivators, an individual’s perception of their lung cancer risk is an important consideration. This paper analyzes factors associated with risk perception in subjects enrolled in the Pan-Canadian Early Detection of Lung Cancer Study (PanCan), and assesses the relationship between subjects’ risk perception and actual calculated risk.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The PanCan low-dose screening CT study recruited individuals from the general population who were current or former smokers age 50-75 having at least a 2% risk of developing lung cancer over 6 years as calculated by the PanCan model. Risk perception was captured at baseline with a 5-point Likert scale question asking the subject to assess their personal chances of being diagnosed with lung cancer compared with other smokers of the same age. Multivariate linear regression analysis was used to assess the relationship between risk factors and risk perception. Baseline risk variables in the model include demographics, smoking history, symptoms, medications, occupation, previous chest imaging, history of COPD, medical comorbidities, and family history of cancer.

      4c3880bb027f159e801041b1021e88e8 Result

      2514 patients were included in the analysis. Median age was 62.3, 55.3% were male, median pack-year smoking history was 50 years (range 2.2-230), and median calculated lung cancer risk was 3.4% over 6 years (range 2-38.2). Calculated lung cancer risk increased by 0.08% (SE 0.02, p-value=0.001) for each increase in Likert risk perception category. On multivariable analysis, the following variables were associated with risk perception category: cigarettes smoked per day (+0.003 increase in category / cigarette, p=0.083), presence of dyspnea (+0.192), presence of wheeze (+0.272), known COPD (+0.110), no family history of cancer (-0.476) and no family history of lung cancer (-0.385) (all p<0.001). Increased perception of risk was associated with intent to quit smoking within 6 months (p<0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      In this lung cancer screening study, risk perception was positively associated with calculated risk for lung cancer, despite a minimum 2% risk in the cohort. Individual factors and family history of cancer predicted risk perception. Risk perception was also associated with a willingness to quit smoking. Self-risk perception and associated factors could be used to tailor recruitment strategies to screening programs. The link between risk perception and willingness to quit smoking could aid integrated tobacco cessation programs.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.13 - Targeted Therapy (Not CME Accredited Session) (ID 962)

    • 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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      P2.13-13 - Real-World Study of Osimertinib in EGFR T790M-Mutated Non-Small Cell Lung Cancer (NSCLC): ASTRIS Canadian Cohort Analysis (ID 12986)

      16:45 - 18:00  |  Author(s): Simon Martel

      • Abstract
      • Slides

      Background

      ASTRIS is an open-label, single-arm, multinational, real world study of osimertinib for patients with advanced/metastatic epidermal growth factor receptor-mutated (EGFRm) T790M-positive non-small cell lung cancer (NSCLC) who previously received therapy with an EGFR tyrosine kinase inhibitor (EGFR-TKI) (NCT02474355). Data cut-off (DCO) for the second interim analysis was 20 October 2017, with 3014 patients enrolled (full analysis set), including 99 patients in Canada.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Adult patients with locally advanced/metastatic EGFRm NSCLC, not amenable to curative surgery/radiotherapy, with confirmation of T790M and prior EGFR-TKI therapy were enrolled. Patients were included with World Health Organization performance status of 0 to 2, as well as those with asymptomatic stable central nervous system (CNS) metastases. Patients received osimertinib 80 mg once daily until loss of clinical benefit. The primary efficacy outcome was overall survival (OS), with secondary outcomes of investigator-assessed response rate (RR), progression-free survival (PFS), and time to treatment discontinuation (TTD).

      4c3880bb027f159e801041b1021e88e8 Result

      From study start (14 January 2016) to DCO (20 October 2017), 99 patients were enrolled at 12 Canadian centres. Median age was 64 years (30-89 years). Patients were 68% female, 57% Asian, and had ECOG 0/1/2 of 22%/65%/13%. Twenty-five patients had CNS metastases at screening. Gefitinib was the most commonly used previous EGFR-TKI (gefitinib, erlotinib and afatinib were 80%, 14%, and 14%, respectively). Thirty-nine percent had previous chemotherapy; 6% previous immunotherapy; 46% previous radiotherapy. All patients had T790M: 75% tissue, 7% blood and 18% cytology. Biomarker testing methods varied, with the majority (61%) identified by Entrogen EGFR kit. At DCO, 45 patients had discontinued treatment. OS data were immature. Median PFS was 11.0 months (95% CI, 8.9-13.3). Median TTD was 14.9 months (95% CI, 11.2-not calculated). RR was 67.0% (95% CI, 56.7-76.2); sub-analyses showed RR of 69.9% (58.0-80.1), 66.7% (22.3, 95.7) and 55.6% (30.8, 78.5) for patients with T790M by tissue, blood and cytology, respectively. Serious adverse events (AEs) were reported for 18% of patients. AEs leading to dose modifications and discontinuations were reported for 12% and 5% of patients, respectively.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The Canadian results from this real world study of osimertinib in advanced/metastatic EGFRm T790M-positive NSCLC, which includes heavily pretreated patients and various approaches to biomarker testing, were comparable to outcomes reported in the phase III study AURA3 (NCT02151981). These findings provide further support for osimertinib as standard of care for EGFRm T790M-positive NSCLC.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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