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Tahir Mehmood



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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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      P1.15-22 - Patterns of Palliative and Psychosocial Care in Stage IV Non-Small Cell Lung Cancer (NSCLC) Patients (ID 12079)

      16:45 - 18:00  |  Presenting Author(s): Tahir Mehmood

      • Abstract

      Background

      The primary goals of management of stage IV NSCLC patients are palliation of symptoms and maintenance of quality of life. Patients need adequate access to specialist palliative care (PC) and psychosocial care (PSC) in order to achieve these goals. The aims of this study were to evaluate referrals to PC and PSC services with Stage IV NSCLC and identify factors associated with utilization of these services.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Research findings of >150 published, peer-reviewed research articles including quantitative and qualitative studies of stage IV NSCLC patients and their families, were summarized around the realities of living with disease. 13 surveys of ~8,000 stage IV NSCLC patients were examined for common concerns. Modified Poisson regression was used to analyze significant factors associated with referrals to PC and PSC. Cox regression was used for multivariate survival analysis.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 923 patients were identified. The median age was 69 years, 63% were male. Active treatment was received by 65% of patients with 34% receiving chemotherapy and 65% receiving radiotherapy. Eighty-three percent of patients were referred to PC, with 67% occurring within 8 weeks of diagnosis. Eighty-two percent of patients were referred to PSC, with referrals to social workers being most frequent (76%) followed by specialist nursing (26%) and psychology/psychiatry (16%). On multivariate analysis, radiotherapy treatment, M1b disease and residential location were associated with PC referrals, and radiotherapy treatment, PC referral and residential location were associated with PSC referrals. Age, language spoken, country of birth, socioeconomic status, year of diagnosis and multidisciplinary team discussion were not significant factors in referral to either service. The median overall survival was 4.3 months and one year survival was 19%. On multivariate analysis, factors associated with improved survival were active treatment, chemotherapy and multidisciplinary team discussion.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Rates of referral to PC and PSC services were high in this cohort suggesting good access to care. Greater referrals were particularly associated with patients undergoing radiotherapy. There were no sociodemographic barriers to referral. Some geographic differences were noted in referrals to both services. Further investigation into referral gaps will guide service delivery to improve quality of life and care for future patients.

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    P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 3
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.17-01 - Trimodality Therapy (TT) in the Treatment of Stage IIIA Non-Small Cell Lung Cancer (NSCLC) (ID 12080)

      16:45 - 18:00  |  Presenting Author(s): Tahir Mehmood

      • Abstract

      Background

      Significant controversy remains regarding the care of patients with clinical stage IIIA NSCLC. While multi-modality therapy is an acceptable strategy, the optimal approach is not firmly established. We analyzed outcomes and predictors associated with TT in stage IIIA NSCLC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The NCDB was queried from 2003-2011 for NSCLC patients diagnosed with stage IIIA-N2 disease and treated with chemotherapy and radiation (CRT). Data was extracted on patient demographics, tumor pathology, treatments and outcomes. Three cohorts of patients were studied - CRT only/no surgery (NS), CRT + lobectomy (L) and CRT + pneumonectomy (P). The univariate and multivariable analyses (MV) were conducted using cox proportional hazards model and log rank tests.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 29,584 patients were included in this analysis: NS-91.7%, L-7%, and P-1.5%. Pt characteristics: median age 66 years; males 56%; whites 86%; academic centers 27%; metro locations 78%; government insured 63%. Patients < 60 years were more likely to receive TT- L (47%), P (60%) vs. NS (29%); p<0.001. Patients in academic centers were more likely to get TT than NS (42% vs. 25%). On MV analysis, L and P had significantly better survival vs. NS: HR 0.43 (0.38-0.48) and HR 0.57 (0.46-0.71) respectively; p <0.001. The median survival of L, P and NS were 44.5 m vs. 25.6 m vs. 15.7 m (p<0.001) and 5- year survival rates (SR) were 44% vs. 33% vs. 14% respectively. 30-day mortality was higher in P vs. L [7% vs. 2.6%; OR 0.26(0.16-0.45); p<0.001]. Patients with <2 lymph nodes (LN) had better survival than with >2 LNs in L (50% vs. 37%; 60m vs. 38.8m) but worse in NS (13.8% vs.16.4%; 15.3m vs.18.5m). On MV analysis of LNs, L had better survival than NS: HR 0.4 (0.35-0.46) in <2 LN patients and HR 0.56 (0.46-0.69) in ≥ 2 LN; p<0.001. For <2 LN, L had better survival than P (60m vs. 25.5m; p<0.0001). L and P had better SR than NS in all ages: 48% vs.37% vs. 19% in ≤60 years; 42% vs. 30% vs.14% in 61-70 years, 36% vs.19% vs. 10% in >70 years.

      8eea62084ca7e541d918e823422bd82e Conclusion

      TT was utilized in less than 10% of patients with stage IIIA-N2 disease, suggesting high degree of patients selection. In this selected group, TT was associated with favorable outcomes relative to CRT alone.

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      P2.17-19 - Concurrent Chemoradiotherapy with Carboplatin-Paclitaxel Versus Cisplatin-Etoposide for Stage III NSCLC Patients – Review of Literature (ID 12041)

      16:45 - 18:00  |  Presenting Author(s): Tahir Mehmood

      • Abstract

      Background

      The two most commonly used chemotherapy regimens deployed concurrently with thoracic radiation (RT) for patients with unresectable IIIA and IIIB non-small cell lung cancer (NSCLC) are carboplatin/paclitaxel (CP) and cisplatin/etoposide (CE). Because there are no prospective comparisons of these two regimens in this setting, we conducted a systematic review of published trials to compare outcomes and toxicities between CE and CP.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Studies which enrolled stage III patients receiving RT with CP or CE were identified using electronic databases and meeting abstracts. Trials were excluded if they were phase I, enrolled less than 10 patients, or included surgical resection. A systematic analysis of extracted data was performed using Comprehensive Meta-Analysis (Version 2.2) software using random and fixed effect models. Clinical outcomes were compared using point estimates for weighted values of median overall survival (OS), progression free survival (PFS), response rate (RR) and toxicities. Two-tailed T-test with a significance level of 0.05 was used for all comparisons.

      4c3880bb027f159e801041b1021e88e8 Result

      3194 patients were included from 32 studies in the CE arm, and 3789 patients from 51 studies in CP. Baseline characteristics of patients on the CE arm versus CP arm were: median age 61 vs. 63 years, male 67.6% vs. 78%, squamous histology 39% vs. 40%, and median radiation dose 62 Gy vs. 63 Gy. There was no significant difference in response rates between CE and CP (65% vs. 56%, p =0.6), respectively. There was no significant difference in median progression free survival (11.5m vs. 9.3m p =0.2), overall survival (19.8m vs. 18.4m, p=0.48), 1-year survival rate (66% vs. 65%, p=0.8), or 3-year survival rate (31% vs. 25%, p=0.4) for CE vs. CP. CE was associated with higher grade 3/4 hematological toxicities than CP, such as neutropenia (53% vs. 23% p<0.0001), thrombocytopenia (14% vs. 6% p=0.001), anemia (16% vs. 8% p=0.06), as well as grade 3/4 nausea/vomiting (20% vs. 9% p=0.018), while rates of grade 3/4 pneumonitis and esophagitis were similar.

      8eea62084ca7e541d918e823422bd82e Conclusion

      CE and CP regimens were associated with comparable efficacy when used with concurrent radiotherapy for stage III unresectable NSCLC patients. The toxicity profile favored the CP regimen.

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      P2.17-20 - Systematic Literature Review of Chemoradiotherapy Versus Radiotherapy Alone in Elderly Patients with Stage III Non-Small Cell Lung Cancer (ID 12042)

      16:45 - 18:00  |  Presenting Author(s): Tahir Mehmood

      • Abstract

      Background

      Young, fit patients with stage III NSCLC have improved survival with the use of combined chemotherapy and radiation therapy (CRT) over radiation therapy (RT) alone – HR 0.74 in a 2010 Cochrane systematic review. Elderly patients have more comorbid illnesses and suffer greater treatment toxicity, thus it is unclear whether they benefit more from CRT over RT. The objective of this systematic review is to explore the evidence base for using CRT in elderly patients with stage III NSCLC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We performed a systematic review including published trials from inception to March 8, 2015, plus relevant conference proceedings since 2000. We included randomized controlled trials (RCTs) of elderly patients (≥70 years old) with stage III NSCLC or elderly subgroups from individual patient meta-analyses comparing CRT versus RT alone. We excluded studies that treated patients with palliative intent, included surgical patients, or in which both arms received chemotherapy. We used a random effects model and inverse variance method to pool time-to-event outcomes. We calculated Peto Odds Ratios (POR) using RevMan 5.3 to pool dichotomous outcomes with a zero cell and otherwise calculated Risk Ratios (RR).

      4c3880bb027f159e801041b1021e88e8 Result

      We screened 2951 citations identifying 68 articles for full text evaluation. Overall survival in elderly patients was superior in those treated with CRT compared to RT (HR 0.66, 95%CI 0.53 to 0.82, I2 0%, p 0.0009). Progression-free survival was also improved with CRT (HR 0.67, 95%CI 0.53 to 0.85, I2 0%, p 0.001). Toxicity assessments were available in two studies with 119 patients receiving CRT and 121 RT. Treatment-related death occurred in 6 (5%) with CRT and 5 (4%) with RT (RR 1.22, 95%CI 0.38 to 3.88) and grade ≥3 pneumonitis was seen in 6 patients in each group, (RR 1.01, 95%CI 0.34 to 3.06) – neither was significantly different between treatments. Neutropenia – 57% v 2% (POR 14.38, 95%CI 8.26 to 25.04) and thrombocytopenia – 30% v 3% (RR 7.62, 95%CI 2.09 to 27.79) were more common with CRT. Febrile neutropenia occurred in 3 (2.5%) patients with CRT and zero patients with RT, but this did not meet significance (POR 7.54, 95%CI 0.78 to 72.82). No studies included patient-reported quality of life.

      8eea62084ca7e541d918e823422bd82e Conclusion

      CRT in elderly patients with stage III NSCLC results in improved survival as compared to RT alone, at the expense of increased treatment-related hematologic toxicity. Quality of life assessment should be included in any future trial design.

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