Virtual Library
Start Your Search
Marisa Bittoni
Author of
-
+
P2.10 - Prevention and Tobacco Control (Not CME Accredited Session) (ID 959)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
-
+
P2.10-10 - Lung Cancer Survival in Younger Patients (<40 Years): Analysis of Surveillance, Epidemiology and End Results Program Data (ID 14411)
16:45 - 18:00 | Presenting Author(s): Marisa Bittoni
- Abstract
Background
Lung cancer is currently the leading cause of cancer deaths in the United States. Past reports have shown an increased incidence of lung cancer in individuals at younger ages, especially under age 40. The purpose of this report is to examine the relationship between lung cancer survival and related factors among individuals <40 versus those over age 40. We examined demographic, clinical and socioeconomic factors, including insurance type.
a9ded1e5ce5d75814730bb4caaf49419 Method
Data for this project were derived from the Surveillance, Epidemiology and End Result (SEER) Program of the National Cancer Institute. SEER consists of 18 population-based, central cancer registries. All lung/bronchus cancer diagnoses from 2007-2014 were obtained using ICD10 codes 34.0-34.9. The following data were collected from the SEER database: year of diagnosis, age, sex, race, insurance, marital status, stage at diagnosis, histology and rural-urban residence. We focused on individuals under age 65 due to insurance and income changes commonly occurring around 65. Hazard ratios (HRs) from Cox proportional hazards regressions models were used to assess differences between those above and below age 40, adjusting for demographic, clinical and socioeconomic factors.
4c3880bb027f159e801041b1021e88e8 Result
Out of 112,400 cases identified for this analysis, 2,134 were <age 40 and 110,283 were over age 40. Slightly more females than males were <40 years (51% vs 49%) compared to those over 40 (53% males vs 47% females) and over 70% of both age groups were white, with a mean age of 33 years for those <40 and 57 years for those >40. Median survival time was shorter for those >40 (19 vs 12 months). Cox proportional hazards regression models revealed a significantly increased probability of dying for individuals under age 40 (HR=1.10, 95%CI=1.04, 1.18), adjusting for covariates. Those with adenocarcinoma and later stage diagnoses had a 4 and 13% increased probability of dying, respectively (p<0.001). Those with private versus no insurance had a 14% decreased probability of dying (HR=0.86, 95%CI=0.82, 0.90; P-trend<0.0001). There were no significant differences in survival according to tumor size, extension and other non-insurance socioeconomic factors.
8eea62084ca7e541d918e823422bd82e Conclusion
This SEER analysis shows that individuals <40 have worse prognosis than individuals >40 (up to 65 years), and that those with private insurance fared better than the uninsured, even after adjustment for important demographic and clinical factors. Future epidemiologic studies of individuals under age 40 are needed and are currently being planned to further assess risk factors for younger individuals and the reasons for worse prognosis.
6f8b794f3246b0c1e1780bb4d4d5dc53
-
+
P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
-
+
P3.01-110 - Defining Aggressive Disease in Patients With Advanced NSCLC Receiving Second-Line Treatment: A Systematic Review (ID 11820)
12:00 - 13:30 | Author(s): Marisa Bittoni
- Abstract
Background
Recent randomized clinical trials (RCTs) have explored survival benefits of second-line treatments (2LTs) in patients who have rapidly progressed and/or are refractory to first-line treatment, and these trials have determined an existing unmet need for these patients with aggressive non-small cell lung cancer (NSCLC). However, specific characterization of aggressive NSCLC is lacking, thus a systematic literature review was conducted to explore the definitions of aggressive NSCLC.
a9ded1e5ce5d75814730bb4caaf49419 Method
We systematically searched Medline, Embase, BioSciences Information Service, the Cochrane Library, and abstracts from scientific meetings (through October 2017) to identify RCTs reporting the efficacy and/or safety of select 2LTs in patients with advanced NSCLC who have characteristics associated with aggressive disease (AD). Six potential overarching categorizations of these characteristics (based on expert clinical opinion) were explored: (1) refractory and/or progressive disease as best response to prior treatment, (2) rapid progression, (3) short duration on previous treatment, (4) high tumor burden or size, (5) short duration since start of last treatment, and (6) high symptom burden.
4c3880bb027f159e801041b1021e88e8 Result
The 14 identified studies had one or more subgroups within five of the six categorizations (11, 2, 1, 2, and 4 studies presented subgroups within categories 1-5, respectively). No RCTs presenting a subgroup of patients for category 6 were identified. Within each category, the identified subgroup definitions varied (15, 4, 3, 2, and 7 different definitions within categories 1-5, respectively). Reporting of whether a subgroup was prespecified or not was limited and often unclear; 6 studies indicated that subgroup analyses of patients with AD characteristics were preplanned. Moreover, baseline characteristics for the subgroup of patients with AD were often not reported.
8eea62084ca7e541d918e823422bd82e Conclusion
Definitions of AD varied, both across the identified studies of 2LTs and within the predetermined categorizations, with refractory being the most frequent followed by short duration since start of last treatment. With the emerging clinical importance of AD, more standard use of these definitions within RCTs may allow for greater comparison across 2LTs and will enable indirect treatment comparisons of the results. As with any subgroup, clarity on preplanned versus post hoc analysis is important for interpretation and should be specified. Additional studies powered to assess treatment benefits in advanced NSCLC patients with AD are needed.
6f8b794f3246b0c1e1780bb4d4d5dc53
