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Kevin Franks
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MA23 - Early Stage Lung Cancer: Present and Future (ID 926)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 10:30 - 12:00, Room 105
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MA23.08 - Discussant - MA 23.05, MA 23.06, MA 23.07 (ID 14613)
11:15 - 11:30 | Presenting Author(s): Kevin Franks
- Abstract
- Presentation
Abstract not provided
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P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)
- 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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P1.16-44 - Minute Ventilation-To-Carbon Dioxide Slope is Associated with Early and Long Term Survivals Following Anatomical Pulmonary Resection (ID 12415)
16:45 - 18:00 | Author(s): Kevin Franks
- Abstract
Background
The aim of study was to identify that ventilation-to-carbon dioxide output (VE/V CO2) slope obtained from cardiopulmonary exercise test (CPET) was an independent prognostic factor of short and long term survival after lobectomy or segmentectomy.The aim of study was to identify that ventilation-to-carbon dioxide output (VE/V CO2) slope obtained from cardiopulmonary exercise test (CPET) was an independent prognostic factor of short and long term survival after lobectomy or segmentectomy.
a9ded1e5ce5d75814730bb4caaf49419 Method
974 patients including lobectomy (n=887) or segmentectomy (n=87) were performed from April 2014 to March 2018. 209 (22%) underwent CPET, and pulmonary function and several clinical factors including age, sex, performance status and comorbidities were retrospectively investigated to identify the prognostic factors with a multivariable Cox regression analysis.
4c3880bb027f159e801041b1021e88e8 Result
Among patients with CPET, 95 patients (46%) had VO2max<15 mL/kg/min. Compared to patients with higher VO2max, they had similar cardiopulmonary complication rates (32% vs. 29%, p=0.68) and 90 day mortality (9.5% vs. 6.2%, p=0.43). 172 patients had measured VE/V CO2. The incidence of cardiopulmonary complications in patients with VE/V CO2 slope >40 was 37% (19 of 51) vs. 27% (33 of 121) in those with lower slope values (p=0.19). However, 90-day mortality in patients with high VE/V CO2 slope (n=8) was 3-fold higher (16% vs. 5.0%) compared to those with lower (n=6) values (p=0.03). Cox regression analysis showed that higher VE/V CO2 values were significantly associated with poorer 2-year survival (HR 1.07, 95% CI 1.01-1.13, p=0.009)
8eea62084ca7e541d918e823422bd82e Conclusion
We found VE/V CO2 slope was associated with increased 90-day mortality and poorer 2-year survival in patients submitted to anatomical pulmonary resection for non-small cell lung cancer. These findings may assist the multidisciplinary team in selecting the most appropriate radical treatment in high-risk patients.
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P2.04 - Immunooncology (Not CME Accredited Session) (ID 953)
- 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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P2.04-21 - Real World Experience of Immune Checkpoint Inhibitors In NSCLC: Our First 10 Months Experience at Leeds Cancer Centre, UK (ID 12419)
16:45 - 18:00 | Author(s): Kevin Franks
- Abstract
Background
Pembrolizumab and Nivolumab are monoclonal antibodies to the PD-1 receptor and have shown significant overall survival(OS) and progression free survival(PFS) in the second line setting compared to chemotherapy in non-small cell lung cancer(NSCLC). Pembrolizumab has shown significant OS and PFS in the first line setting in high PD-1 expressors(>50%).
In January 2017, immune checkpoint inhibitors became standard of care in the UK initially in the second line setting and subsequently first line later that year.
Studies report fewer treatment-related adverse events in the checkpoint inhibitor arm Vs chemotherapy (10-20% Vs 54%).
We report our first 10 months experience with routine use of checkpoint inhibitors in NSCLC at Leeds Cancer Centre(LCC), UK.
a9ded1e5ce5d75814730bb4caaf49419 Method
All patients receiving pembrolizumab and nivolumb between 1/1/17 and 31/10/17 at LCC, UK were included. Retrospective review of medical notes was performed and outcomes recorded including: checkpoint inhibitor received; time to response; OS and treatment-related adverse effects. Kaplan-Meier survival curves were used to assess survival outcomes.
4c3880bb027f159e801041b1021e88e8 Result
Thirty-six patients received checkpoint inhibitors during this period. Median age was 68 years.
Eleven patients received first line therapy with a response rate of 90% (n=10). Twenty-five patients received second line therapy with a response rate of 32% (n=8). For the whole cohort, median time to response was 52days. Median time to progression in responding patients was not reached.
Median PFS was 152days (95%CI 57-232). Median OS was 467days (95% CI 194-not reached).
Pseudoprogression occurred in one patient.
Treatment-related adverse effects occurred in 58% (n=21). Of these, 57% (n=12) were non-autoimmune and 43% (n=9) were autoimmune. Grade 3-5 toxicities occurred in 8% (n=3), all were autoimmune mediated on pembrolizumab. In all cases, treatment was stopped.
Thirty-one percent (n=11) remain on check-point inhibitors.
8eea62084ca7e541d918e823422bd82e Conclusion
Overall response rate to immune checkpoint inhibitors in this small cohort was better than reported data in both the first and second line setting (90% Vs 45% and 32% Vs 19% respectively).
Time to response was comparable to previous trials (1.7months Vs 2.1months).
Median PFS and OS were in keeping with large randomised controlled trials (PFS - 5months Vs 2.3-10.3months and OS - 15months Vs 12.2months).
Frequency of treatment-related adverse effects and grade 3-5 effects were lower in this cohort at 58% and 8% respectively, compared to 69-73.4% and 10-26.6% in trials.
In conclusion, our initial results in this real world cohort show immune checkpoint inhibitors are a safe, effective treatment in this group of patients.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 2
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.16-16 - SABRTOOTH: A Fasibility Study of SABR Versus Surgery in Patients with Peripheral Stage I NSCLC Considered to be at Higher Risk for Surgery. (ID 13679)
16:45 - 18:00 | Presenting Author(s): Kevin Franks
- Abstract
Background
Stage I NSCLC is curable by surgery and Stereotactic Ablative Radiotherapy (SABR). Many patients have co-morbidities that place them at higher risk of surgical complications. For such patients it is unknown whether the potential benefits of surgery are outweighed by the risks since published randomised trials comparing surgery with SABR have been underpowered. The SABRTooth study was designed to determine the feasibility of randomising patients between the two treatments and thus performing a larger RCT.
a9ded1e5ce5d75814730bb4caaf49419 Method
Four thoracic oncology centres and a referral site participated. Patients with peripheral (>2cm from the main airways) stage T1-T2bN0M0 NSCLC were considered for study entry. Patients at higher risk were identified using several criteria including Thoracoscore and the Nottingham Risk Score and confirmed by multidisciplinary team consensus.
Eligible patients were approached by a respiratory physician and research nurse, consented and randomised (1:1) before consulting a surgeon or oncologist. Surgery was preferably by lobectomy with lymph node sampling/resection although sub-lobar resection was permitted. SABR was delivered as per the UK SABR guidelines.
An average recruitment rate of 3 patients/month from the 5 centres over a formal monitoring period was set to prove feasibility of a larger RCT. Meetings with the trial sites and patient representatives were held through-out to improve recruitment. Qualitative research was embedded into the study with interviews for patients who declined participation or randomised treatment.
4c3880bb027f159e801041b1021e88e8 Result
Between July 2015-January 2017 318 patients were assessed for eligibility of which 106 were initially considered eligible. 84 patients were approached for the study and 24 (29%) were randomised (10 surgery, 14 SABR); a mean recruitment rate of 1.7 per month. The median age was 75 (range 54-88). The main reason for declining the study was patient preference with 29% preferring surgery and 42% SABR. Overall 9/24 (38%) did not receive their randomised treatment. Of 7 patients randomised to surgery, 6 received SABR, 1 radical radiotherapy and of 2 patients randomised to SABR, 1 received radical radiotherapy, 1 was lost to follow-up.
8eea62084ca7e541d918e823422bd82e Conclusion
Despite recruiting at higher rate/centre than previous SABR versus surgery trials, the SABRTooth study failed to meet its recruitment target and the majority of patients randomised to surgery subsequently underwent SABR. Therefore, conducting a large RCT in the UK was shown not to be feasible. However, establishing which patients should have surgery or SABR for early stage NSCLC remains a critical question and alternative study designs are being developed to provide an answer for patients and clinicians.
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P2.16-17 - Hypo-Fractionated Accelerated Radiotherapy in Central Early Non-Small Cell Lung Cancer: Leeds Cancer Centre Experience. (ID 13503)
16:45 - 18:00 | Presenting Author(s): Kevin Franks
- Abstract
Background
Centrally located early stage lung cancers in patients who are unfit for surgery and stereotactic ablative body radiotherapy (SABR) are routinely treated with radical radiotherapy. There are no standard dose regimens but evidence seems to favour acceleration. We present the outcomes of a moderately hypo-fractionated accelerated dose regimen of 50Gy in 15 fractions (BED (a/b=10) corrected for time = 58.85Gy) from a single centre in the UK.
a9ded1e5ce5d75814730bb4caaf49419 Method
Electronic case notes and radiotherapy records of lung cancer patients treated between January 2014 to December 2016 were retrospectively reviewed. Adult Comorbidity Evaluation-27 (ACE-27) score was used to evaluate comorbidities. Survival outcomes were estimated using Kaplan-Meier curves and compared using log-rank test.
4c3880bb027f159e801041b1021e88e8 Result
Fifty-three patients were treated with 50Gy in 15 fractions with a median age of 74.0 years (IQR: 69.5–79). 4 patients had a poor WHO PS of 3. Thirty-seven (69.8%) were females. A similar number had Grade 2 or 3 ACE-27 score while one had Grade 0. Forty-six patients were stage I, whilst four and three patients were stage II and III respectively. Thirty-seven (70%) patients had a radiological diagnosis.
The treatment was well tolerated, 90-day mortality rate after radiotherapy was 3.8% (n=2). Grade 2 pneumonitis was seen in 5 patients while no grade 3 or 4 pneumonitis was observed. At the time of cut-off for analysis, the median follow-up was 20.2 months. The median progression-free survival (PFS) and overall survival (OS) were 18.5 months (95% CI 12.2–24.8) and 28.2 months (95%CI 14.4–42.1) respectively. The estimated 1 and 2 year PFS were 62.3% and 41.3% respectively and OS were 77.4% and 56.6% respectively. Only PS significantly impacted survival on univariate analysis, while PS and ACE-27 both were shown to have significant effect on multivariate analysis.
Of the nineteen patients who relapsed, 4 (7.5%) had infield recurrence, 10 had out-of-field lung recurrence and the rest had distant metastases. One patient underwent salvage surgery. 6 patients received further radical therapy with 3 each being treated with conventional and SABR.
8eea62084ca7e541d918e823422bd82e Conclusion
This moderately hypo-fractionated accelerated radiotherapy regimen for central early stage lung cancer seems similar in efficacy but is associated with significantly less toxicity when compared to SABR.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.16-08 - Baseline Quality of Life is Influenced by the Duration of Abstinence from Smoking in Candidates to Lung Cancer Surgery (ID 12350)
12:00 - 13:30 | Author(s): Kevin Franks
- Abstract
Background
The optimal interval of smoking cessation before Non-Small Cell Lung Cancer (NSCLC) surgery is still unknown. The objective of this study is to evaluate the influence of smoking cessation on the preoperative quality of life (QoL) of surgical NSCLC patients.
a9ded1e5ce5d75814730bb4caaf49419 Method
266 consecutive ever smokers (133 females) with a pack year history >=20 undergoing lung resections for NSCLC and with complete preoperative QoL data were analysed. The EORTC QoL summary score was calculated (SumS) as the average of the individual functional and reversed symptom scales (excluding Global-Health and Financial-Impact scales). The following smoking-related variables were tested for a possible association with SumS: age when the patient quit smoking and months elapsed from smoking cessation (for current smokers a value of 0 was used). These variables were entered as independent predictors in a stepwise multivariable regression analysis along with several patient-related baseline factors.
4c3880bb027f159e801041b1021e88e8 Result
108 patients were current smokers, 158 were ex smokers (quit at least 1month before surgery). We found no difference of preoperative QoL SumS between current smokers and ex smokers (81.5 vs. 83.0, p=0.66). Amongst the 158 ex-smokers, 69 quit smoking before the age of 60. Their SumS was similar to the one of those who quit older (84.2 vs. 82.0, p=0.30). A linear regression showed a significant association between the duration of abstinence from smoke and their QoL SumS (coefficient 0.02, SE 0.009, p=0.03). When the analysis was adjusted for other confounders using a multivariable regression analysis, the duration of abstinence from smoking (p<0.0001-longer time better QoL)(Fig1) and the age at which the patient quit smoking (p=0.001-older age better QoL)remained independently associated with SumS along with performance score.
Figure 1: Lowess Curve plotting SumS against the months elapsed from the time quit smoking.
8eea62084ca7e541d918e823422bd82e Conclusion
Patients should be counselled to stop smoking prior surgery independently as the QoL has expected to increase.
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