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Ifigenia Constantinou

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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: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.17-07 - Concurrent Chemoradiotherapy (ConCRT) using Cisplatin-Vinorelbine in Locally Advanced (LA) Non-Small Cell Lung Cancer (NSCLC)<br />   (ID 14097)

      16:45 - 18:00  |  Author(s): Ifigenia Constantinou

      • Abstract
      • Slides


      We adopted ConCRT with cisplatin and vinorelbine as our standard of care for patients with LA NSCLC since 2005. This is an analysis of a register of all patients consecutively assigned ConCRT since 2005 in an intent to treat analysis.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From Feb 2005 to Dec 2015 we assigned ConCRT for 77 consecutive patients with LA NSCLC, who were deemed unresectable; this included T4/N3/ “bulky” N2 disease or locally recurrent disease after initial surgery. Patients had ECOG performance status 0-2 and were treated with Cisplatin 75mg/m2 d1 and Vinorelbine 30mg/m2 d1-8, 3-weekly during the induction chemotherapy phase (i.e. full doses for the first 1-2 cycles) whilst with the addition of radical RT, Vinorelbine was reduced to 12.5mg/m2 d1-8. After ensuring acceptable toxicity with the first 11 patients treated, subsequent patients received Vinorelbine at 15mg/m2 d1-8 during ConCRT and the number of treatment cycles was escalated to a maximum of 6. Patients received definitive CRT (59.4-64.8 Gy) unless surgery was planned, in which case restaging evaluation for potentially resectable patients was performed at 45-50.4 Gy. PET staging was only available since 2011.

      4c3880bb027f159e801041b1021e88e8 Result

      77 patients: 69 men and 8 women. Median age was 63 (43-81); PS 0-1 n=69, PS 2 n=8. Radiological stage IIIB n=40 (52%), IIIA n=30 (39%), IIB n=7 (9%). Histology, squamous n=42, adenocarcinoma n=21, other NSCLC n=14. Treatment delivered: median 4 cycles (range 1-6). 71 patients (92%) completed ConCRT. Overall response rate 70% (49 partial and 5 complete responses), stable disease n=7, progressive disease n=8; of the remaining 8 non-evaluable patients, 6 patients did not complete ConCRT, either due to toxicity/death or disease progression. 11 patients who received ConCRT underwent surgery (6 lobectomies, 5 pneumonectomies). 6 of these 11 patients had a complete pathologic response (pCR). Median progression-free survival (PFS) 14.4 months (C.I. 9.0-19.8) and median overall survival (OS) 23.8 months (C.I. 17.2-30.4). Five year OS rate was 28.2%. There were 2 toxic deaths from neutropaenic sepsis during concurrent CRT and one after surgery. The incidence of grade 3-4 oesophagitis or pneumonitis was < 10% and manageable.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This regimen has produced encouraging results with a 23.8 month median OS in a patient cohort with predominantly IIIB disease and with a significant minority of poor PS=2 patients, with 92% being able to complete the treatment. Finally 8% of patients had pathological pCR, with 28% of patients treated achieving long-term survival.


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