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Carlos Chaib
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Lunch & Poster Display session (ID 58)
- Event: ELCC 2019
- Type: Poster Display session
- Track:
- Presentations: 2
- Moderators:
- Coordinates: 4/11/2019, 12:30 - 13:00, Hall 1
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44P - Temporal trends in treatment (Tx) and overall survival (OS) among patients (pts) with incident NSCLC in the UK: A real-oncology database analysis from the I-O Optimise initiative (ID 514)
12:30 - 13:00 | Author(s): Carlos Chaib
- Abstract
Background
As part of I-O Optimise, a multinational research platform providing real-world insights into the management of lung cancers, temporal trends for initial Tx and OS are reported for pts diagnosed with NSCLC at Leeds Teaching Hospitals Trust (LTHT), hosting one of the largest integrated cancer centres in the UK.
a9ded1e5ce5d75814730bb4caaf49419 Methods
A retrospective cohort study using longitudinal data collected from electronic medical records at LTHT, including all adult pts diagnosed with NSCLC from Jan 2007 to Aug 2017 (follow-up to Mar 2018). Initial Tx was the 1st Tx received after diagnosis (categorised as surgery, radiotherapy or systemic anti-cancer therapy [SACT]). In this analysis, 2 diagnostic periods were compared: 2007–2012 and 2013–2017. Kaplan–Meier methods were used for OS.
20c51b5f4e9aeb5334c90ff072e6f928 Results
Among 3739 pts with incident NSCLC, TNM stage distribution was: I, 19.2% (this increased noticeably from 14.0% in 2007–2012 to 24.8% in 2013–2017); II, 11.6%; IIIA, 12.5%; IIIB, 9.0%; and IV, 47.7%. Overall, 29.7% had non-squamous cell carcinoma (NSQ), 21.9% had squamous cell carcinoma (SQ), 11.7% had NSCLC NOS (this decreased noticeably from 18.8% in 2007 to 8.4% in 2016) and 2.4% had other histology; 34.3% of pts were diagnosed without pathology. Tx patterns for NSQ and SQ pts are shown by stage and year of diagnosis (
fd69c5cf902969e6fb71d043085ddee6 ConclusionsTable ). Between 2007–2012 and 2013–2017, median OS (in months) increased noticeably in stage I–IIIA NSQ (28.7 to 50.0) and SQ pts (17.4 to 32.1), but not in stage IIIB–IV NSQ (4.1 to 5.0) or SQ pts (5.3 to 4.8)Temporal changes in initial Tx (within 6 months of diagnosis) by pathology, TNM stage and year of diagnosis* Stage I Stage II Stage IIIA Stage IIIB Stage IV 2007-2012 2013-2017 2007-2012 2013-2017 2007-2012 2013-2017 2007-2012 2013-2017 2007-2012 2013-2017 NSQ n = 64 n = 159 n = 61 n = 51 n = 51 n = 57 n = 49 n = 40 n = 296 n = 281 Treatment (%) Surgery alone 56.3 67.3 41.0 37.3 13.7 12.3 0.0 0.0 2.0 M Surgery + SACT/RT M M 21.3 21.6 9.8 17.5 0.0 0.0 M M RT alone 29.7 22.6 13.1 21.6 0.0 14.0 20.4 17.5 18.6 23.8 SACT + RT 0.0 0.0 9.8 M 21.6 33.3 24.5 30.0 16.2 17.1 SACT alone M M M M 13.7 14.0 24.5 37.5 22.0 31.0 Untreated (%) 7.8 3.1 11.5 M 15.7 M 30.6 15.0 39.2 26.3 SQ n = 58 n = 69 n = 58 n = 74 n = 91 n = 72 n = 68 n = 49 n = 161 n = 118 Treatment (%) Surgery alone 43.1 62.3 29.3 29.7 15.4 11.1 0.0 0.0 M M Surgery + SACT/RT M M 10.3 17.6 M M 0.0 0.0 M M RT alone 39.7 33.3 41.4 29.7 41.8 33.3 36.8 32.7 24.2 26.3 SACT + RT M 0.0 M 10.8 24.2 31.9 36.8 32.7 26.7 20.3 SACT alone M 0.0 0.0 M M 11.1 11.8 14.3 16.8 21.2 Untreated (%) M M 13.8 10.8 13.2 8.3 14.7 18.4 29.2 27.1 Data for patients with only clinical diagnosis and patients with initial treatment >6 months after diagnosis are not shown.
M, masked as < 5 patients; RT, radiotherapy.
OS improved in stage I–IIIA pts over time, most likely due to an increased proportion diagnosed at stage I and the evolution of initial Tx through the study period. In contrast, among stage IIIB–IV pts, SACT use remains relatively low and OS outcomes remain unchanged. Future analyses will help assess the impact of new therapies, including immunotherapy and 2nd-generation tyrosine kinase inhibitors, on Tx patterns and OS in the UK.
b651e8a99c4375feb982b7c2cad376e9 Editorial acknowledgement
Editorial assistance was provided by Richard Daniel, PhD, of Parexel and funded by Bristol-Myers Squibb.
934ce5ff971f1ab29e840a35e3ca96e9 Legal entity responsible for the study
Bristol-Myers Squibb.
213f68309caaa4ccc14d5f99789640ad Funding
Bristol-Myers Squibb through an EU wide RWD initiative called IO-Optimize sponsored by BMS.
682889d0a1d3b50267a69346a750433d Disclosure
M. Snee: Grants, personal fees: IQVIA, during the conduct of the study. L. Lacoin: Consultant epidemiologist contracted by Bristol-Myers Squibb. W. Sopwith: Personal fees: IQVIA, during the conduct of the study and outside the submitted work. C. Chaib: Employee: Bristol-Myers Squibb; Bristol-Myers Squibb (BMS) is funding this work through an EU wide RWD initiative called IO-Optimize sponsored by BMS. J.R. Penrod: Employment, stock ownership: Bristol-Myers-Squibb. J.C. O’Donnell: Employee, shareholder: BMS. All other authors have declared no conflicts of interest.
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45P - Treatment (Tx) patterns and overall survival (OS) in patients (pts) with stage IIIB–IV NSCLC in Portugal: An IPO-PORTO database analysis from the I-O Optimise initiative (ID 210)
12:30 - 13:00 | Author(s): Carlos Chaib
- Abstract
Background
Understanding Tx patterns and related outcomes in the rapidly changing NSCLC landscape informs clinical decision-making. As part of I-O Optimise, a multinational research platform providing real-world insights into the management of lung cancers, Tx patterns and OS are reported for pts with NSCLC prior to immunotherapy reimbursement in Portugal.
a9ded1e5ce5d75814730bb4caaf49419 Methods
IPO-Porto, Portugal’s largest oncology hospital, has a research database linked to the RORENO cancer registry, covering northern Portugal. This database has collected data on 1524 adult pts with NSCLC since 2012; the current analysis includes pts diagnosed at stage IIIB–IV from Jan 2015 (when systemic anticancer therapy [SACT] data became available) to Dec 2016 (follow-up to Jun 2017). Tx patterns are shown for the first 3 Tx lines. Kaplan–Meier methods were used for OS and time to next Tx or death (TTNT) from SACT initiation.
20c51b5f4e9aeb5334c90ff072e6f928 Results
Of 595 pts diagnosed at stages I–IV in 2015–2016, 54 (9.1%) had stage IIIB and 338 (56.8%) had stage IV NSCLC (median age, 65 yrs [range: 27–90; 9.2% ≥80]; male, 77.3%; brain metastases, 16.3%; non-squamous [NSQ], 73.7%; squamous [SQ], 21.2%). Of the 372 NSQ/SQ pts, 284 (76.3%) had 1st-line SACT; 101 (27.2%) had 2nd-line, and 20 (5.4%) had 3rd-line (
fd69c5cf902969e6fb71d043085ddee6 ConclusionsTable ). Median OS from SACT initiation was 12.6 (NSQ) or 10.3 (SQ) months. Median OS was longer in stage IV pts without brain metastases (11.6 vs 7.6 months), and in treated NSQ pts with EGFR/ALK alterations vs wild type (14.4 vs 9.3 months). Most NSQ pts with EGFR/ALK alterations (73.0%) had a 1st-line tyrosine kinase inhibitor (TKI). Median TTNT was 11.0 months in NSQ pts on 1st-line TKI and 6.3 (NSQ) or 7.3 (SQ) months in pts on 1st-line platinum chemotherapySACT regimen (%) Non-squamous Squamous 1st-line Tx n = 221 n = 63 Platinum-based chemotherapy 72.9 87.3 Non-platinum single agent 4.5 12.7 TKI (any) 22.6 0.0 Erlotinib 12.7 0.0 Crizotinib 2.3 0.0 Gefitinib 7.7 0.0 Anti-PD-1/anti-PD-L1 checkpoint inhibitors 0.0 0.0 2nd-line Tx n = 82 n = 19 Platinum-based chemotherapy 13.4 21.1 Non-platinum single agent 59.8 73.7 TKI (any) 24.4 0.0 Erlotinib 9.8 0.0 Crizotinib 11.0 0.0 Other TKI 3.6 0.0 Anti-PD-1/anti-PD-L1 checkpoint inhibitors 2.4 5.3 3rd-line Tx n = 17 n = 3 Platinum-based chemotherapy 35.3 0.0 Non-platinum single agent 41.2 100.0 TKI (any) 11.8 0.0 Erlotinib 5.9 0.0 Crizotinib 0.0 0.0 Anti-PD-1/anti-PD-L1 checkpoint inhibitors 11.8 0.0 PD-1, programmed death-1; PD-L1, programmed death-ligand 1
Pts with advanced NSCLC have a high burden of disease, with most diagnosed at stage IV and a short OS from SACT initiation. Future analyses will assess the post-reimbursement impact of immunotherapies (and new TKIs) on Tx and OS in Portugal.
b651e8a99c4375feb982b7c2cad376e9 Editorial acknowledgement
Professional medical writing assistance was provided by Richard Daniel, PhD, of Parexel and funded by Bristol-Myers Squibb.
934ce5ff971f1ab29e840a35e3ca96e9 Legal entity responsible for the study
Bristol-Myers-Squibb.
213f68309caaa4ccc14d5f99789640ad Funding
Bristol-Myers-Squibb through an EU wide RWD initiative called IO-Optimize sponsored by BMS.
682889d0a1d3b50267a69346a750433d Disclosure
M.A.S. Soares: Advisory boards, talks: Roche; Lilly, BMS, MSD; Boehringer Ingelheim, Pfizer, AstraZeneca, Novartis, outsider the submitted work. L. Antunes, P. Redondo, M.J. Bento: Grants: IQVIA, during the conduct of the study. M. Borges: Grants: IQVIA to IPO Porto, during the conduct of the study. R. Hermans, F. Grimson, R. Munro: Employee: IQVIA Real-World Insight Solutions (vendor paid by BMS). D. Patel: Personal fees: BMS, during the conduct of the study. C. Chaib: Employee: Bristol-Myers Squibb. L. Lacoin: Consultant epidemiologist contracted by Bristol-Myers-Squibb. All other authors have declared no conflicts of interest.
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