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Keaton D Bedell



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    P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)

    • 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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      P2.01-42 - Impact of Tobacco Smoking on Outcomes in Patients with Metastatic Non-Small Cell Lung Cancer in the Era of Targeted Therapy (ID 13849)

      16:45 - 18:00  |  Author(s): Keaton D Bedell

      • Abstract
      • Slides

      Background

      Prior epidemiological studies have noted differences in the demographic and clinical characteristics among patients with metastatic non-small cell lung cancer (NSCLC) between those with and without exposure to tobacco smoke. Most notably never smokers are more likely to harbor genomic driver mutations and (in the era of targeted therapy) improved survival. Observational databases, capturing real world diagnostic and treatment patterns, can provide insights on outcomes of NSCLC based on smoking history.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The electronic health records (EHR) of patients with de novo stage IV NSCLC diagnosed between January 2013 and December 2016 from 30 cancer centers, contributing to the Cota Observational Cancer Database, from 184 oncologists were reviewed.

      4c3880bb027f159e801041b1021e88e8 Result

      1716 NSCLC pts were identified including 243 (14.2%) never tobacco smokers, 405 (23.6%) active smokers, 1026 (59.8%) former smokers, 7 (0.4%) passive smokers, and 29 (1.7%) not reporting. Never Smokers (NS) were more likely than smokers (S=active and former smokers combined) to be female (NS: 67.4%; S: 47.2%; p<0.0001) with similar ages (NS: 66 yrs; S: 67 yrs), but included more Asians pts (7.4% vs 1%, p<0.0001). Histologic subtypes differed: Squamous NS: 9%; S: 17.8%: (p<0.0001), AdenoCA NS: 73.2%; S: 68% (p=0.1), NOS N: 5.3%; S: 6.1% (p=0.8). Genomic profiling for EGFR/ALK was more common and identified more mutations in the NS cohort. In the non-squamous histologies EGFR testing was NS: 87% with 45.9% mutated; S: 70% with 10.4% mutated (tested p<0.0001; mutated p<0.0001). In the non-squamous histologies ALK testing was NS: 74% with 5.4% translocated ; S: 67% with 1.4% translocated (tested p=0.04; translocated p<0.001). As first line therapy 40% of NS received targeted therapy (11% receiving targeted 2nd line) whereas 4.8% S received 1st line and 1.5% 2nd line targeted therapy. The median overall survival for the NS cohort was 21 months compared to 11 months among S (log-rank p<0.05); with PFS of 9 vs 6 months (p<0.05). Excluding use of targeted therapy in 1st or 2nd line, the median OS for NS was 17 mo; for S was 10 mo (p<0.05).

      8eea62084ca7e541d918e823422bd82e Conclusion

      This real world observational study confirms a higher rate of targetable genomic driver mutations among never smoker NSCLC. Despite guidelines recommending universal genomic testing, never smokers are tested at a higher frequency. In the era of targeted therapy (but before the widespread use of immunotherapy) never smoker NSCLC patients experienced improved overall survival with and without targeted treatment compared to individuals with tobacco exposure.

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