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Paula Scullin
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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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P2.17-09 - Exploring the Impact of Age on the Efficacy of Adjuvant Chemotherapy After Radical Resection in Non- Small Cell Lung Cancer (ID 14108)
16:45 - 18:00 | Author(s): Paula Scullin
- Abstract
Background
Most adults diagnosed with Non Small Cell Lung Cancer (NSCLC) are over 65 years old. For those with resectable disease postoperative cisplatin-based chemotherapy (PC) has been shown to offer a significant survival advantage. However elderly patients are poorly represented in clinical trial cohorts, here we shall explore our regional experience of treating these patients.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients receiving PC with Vinorelbine 25mg/m2, D1 & 8/ Cisplatin 75mg/m2 (VC) following surgery for NSCLC between January 2004 and April 2017 were identified from the electronic computer database. Patients with synchronous tumours or metastatic disease were excluded.
4c3880bb027f159e801041b1021e88e8 Result
165 patients were identified, 63 (38%) >65yrs (range 65-77yrs). All were ECOG PS 0-1. 12 patients had Stage 1B disease (7 >65yrs), 63 Stage II A (20 >65yrs), 40 Stage IIB (21 >65yrs) and 50 Stage IIIA/B disease (17 >65yrs).
53.9% of patients > 65yrs compared to 81% patients < 65yrs completed 4 cycles of PC.19% of patients required dose reductions due to toxicity, 12 were over 65yrs. Grade 3/4 neutropenia occurred in 21.2% of patients (18<65yrs vs. 17 >65 yrs) and febrile neutropenia in 9 patients > 65yrs vs. 11<65yrs. No toxic deaths were recorded.
Overall 85 (51.5%) patients, 26 >65yrs had radiological evidence of disease recurrence. The median time to recurrence was 26.19 months, no significant difference was found in time to relapse based on age (p=0.21). Kaplan Meyer analysis revealed no significant difference in overall survival based on age (p=0.77, HR1.069 95%CI 0.68-1.67). Mortality 6 months post chemotherapy in patients > 65yrs was 1.58% vs. 2.94% inpatients < 65yrs.
8eea62084ca7e541d918e823422bd82e Conclusion
This illustrates in routine practice, PC using VC is deliverable in older patients of good PS with resected NSCLC. Though they may experience more toxicity from PC the benefits in terms of disease recurrence and overall survival were equivalent to patients <65yrs.
6f8b794f3246b0c1e1780bb4d4d5dc53
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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
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P3.01-23 - Imaging Modalities for Surveillance and Follow-Up of Patient with Lung Cancer After Adjuvant Chemotherapy (ID 13201)
12:00 - 13:30 | Author(s): Paula Scullin
- Abstract
Background
Non-small cell lung cancer (NSCLC) represents over 80% of lung tumours. If diagnosed early, treatment is surgical with curative intent. The addition of postoperative cisplatin-based chemotherapy has demonstrated a significant survival advantageand is generally accepted as a standard treatment in patients of good performance status.
Despite this, risk of relapse remains high and current ESMO (2017) guidance suggests ‘NSCLC patients treated with radical intent should be followed for treatment-related complications, detection of treatable relapse or occurrence of second primary lung cancer. Recommendations for surveillance, include regular review, physical exam and imaging. This should be tailored to suitability of individual patients for further intervention. Local practice mandates a chest x-ray (CXR) with CT and/or PET follow-up of anomalies.
a9ded1e5ce5d75814730bb4caaf49419 Method
Between January 2004 and May 2017 165 patients underwent surgical resection for Stage 1B-IIIA NSCLC. We identified all patients within this cohort with radiological evidence of thoracic recurrence who had relapsed following postoperative chemotherapy. Electronic patient care records were used for data collection. Patient characteristics, surveillance modalities and overall survival (OS) from date of diagnosis to first relapse were analysed. Imaging modalities detecting recurrence and OS were determined using Kaplan-Meier methodology (SPSS).
4c3880bb027f159e801041b1021e88e8 Result
89 patients were identified, the median age was 62 years (range 42-77 years). Patients underwent surveillance initially every 3 months following completion of postoperative chemotherapy. Median time to relapse was 25.6 months (range 0.53 to 50.9 months). 62 patients (69.7%) had radiological confirmed evidence of disease recurrence. 4 (6.5%) had relapsed with extra-thoracic recurrence. 28 patients (45.2%) had confirmed intra thoracic disease recurrence on CXR despite chest CT imaging performed at designated time intervals. However, 27 patients (43.5%) that underwent surveillance with CXR had confirmed intra thoracic disease recurrence with chest CT imaging. Median OS for CXR detected recurrence was 27.5 months (range 6.5 – 99.1 months) and 27.45 months (range 5.9 to 104.2 months) for chest CT detected recurrence (p-value 0.46).
8eea62084ca7e541d918e823422bd82e Conclusion
There is a paucity evidence specifically around the follow-up and surveillance modalities aimed at detecting relapse to improve survival after curative intent therapy in NSCLC.Our data demonstrate that 3 monthly CXR is an appropriate surveillance modality for initial detection of intra-thoracic disease recurrence.
6f8b794f3246b0c1e1780bb4d4d5dc53
