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Narjust Duma



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    EP1.15 - Thymoma/Other Thoracic Malignancies (ID 205)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.15-08 - Association of Perioperative Chemotherapy with Survival in Thymic Malignancies (ID 1436)

      08:00 - 18:00  |  Author(s): Narjust Duma

      • Abstract
      • Slides

      Background

      Patterns of perioperative chemotherapy utilization and its association with survival in thymic malignancies are largely unknown.

      Method

      We queried NCDB from years 2004-2014 and identified 3,788 patients with non-metastatic thymic carcinoma (TC) and thymoma who received surgery. We compared patients who received perioperative chemotherapy to those who didn't and used a Cox proportional hazards model to determine predictors of mortality.

      Result

      764 patients (20%) received chemotherapy: 287(38%) neoadjuvant (NAC), 347(45%) adjuvant (AC), and 130(17%) unspecified. 184(24%) had TC; the rest had thymoma. Patients who didn’t receive chemotherapy (N=3024) had older age (median 62 vs 47, P<0.01) and earlier stage (51% versus 24% stage I-IIA, P<0.01). In multivariable analysis, patients who received AC versus no chemotherapy had a similar overall survival(OS); however, NAC predicted a worse OS. For separate thymoma and TC subsets, median OS did not differ between those who received AC and those who didn’t in either group. AC did not improve OS for patients with R1/R2 margins (114 months, 95%CI 94-NR vs 131 months, 95%CI 118-NR)

      Characteristic

      Hazard ratio for mortality (95% confidence interval) 1

      Age

      1.03 (1.03-1.04)

      Thymoma vs. TC

      0.50 (0.43-0.58)

      Charlson-Deyo score>0

      1.40 (1.21-1.63)

      Chemotherapy

      None

      Adjuvant

      Neoadjuvant

      Unclassified

      1

      1.13 (0.89-1.44)

      1.77 (1.37-2.27)

      1.60 (1.16-2.19)

      Masaoka-Koga Stage

      I-IIA

      IIB

      III

      Unknown/other

      1

      1.08 (0.88-1.34)

      1.59 (1.34-1.90)

      2.71 (2.01-3.65)

      Radiation

      0.78 (0.67-0.91)

      Positive margin

      1.55 (1.33-1.81)

      1Model included sex, academic center, insurance, and race/ethnicity

      tc_surv_plot_stages_chemo_thymic_carcinoma.jpg

      tc_surv_plot_stages_chemo_thymoma.jpg

      Conclusion

      Chemotherapy in the perioperative setting was not associated with improved OS in either TC or thymoma. Prospective controlled studies are needed to determine the role of perioperative chemotherapy in thymic malignancies.

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    P1.12 - Small Cell Lung Cancer/NET (ID 179)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.12-11 - Exploring Sex Differences in Small Cell Lung Cancer: Is This a Hormonal Issue? (ID 605)

      09:45 - 18:00  |  Presenting Author(s): Narjust Duma

      • Abstract
      • Slides

      Background

      Small cell lung cancer (SCLC) accounts for about 10% to 15% of lung cancers among women and men. Though heavily associated with smoking, its incidence in women is rapidly increasing despite a decline in cigarette exposure. Given the changing demographics of SCLC and hormonal factors associated with other forms of lung cancer, we studied differences between sexes in SCLC.

      Method

      Utilizing the National Cancer Database, we identified all incident SCLC cases from 2004 to 2014. Patients were classified as limited (LS) or extensive stage (ES). Women were stratified by menopausal status (≥55 years = postmenopausal). Kaplan-Meier method and Cox regression were used for overall survival (OS) and multivariable analysis.

      Result

      161,978 patients were identified. No significant sociodemographic differences were observed between sexes. The majority of patients were non-Hispanic whites (89.1%), followed by non-Hispanic blacks (7.5%). Men were more likely to be diagnosed with ES disease than women (63% vs. 56%). Both sexes initiated treatment within a similar time frame from diagnosis (chemotherapy, median 18 days, IQR 8-32). Women had better median OS compared to men in both LS (15.2 vs. 12.7 months, HR: 0.85, 95% CI 0.83-0.86, p < 0.0001) and ES (6.4 vs. 5.7 months, HR: 0.88, 95% CI 0.87-0.90, p < 0.0001). No racial or ethnic disparities in OS were observed, overall and when examined within sex and disease stage groups. Differences between sexes in OS were also observed when comparing patients within the same racial/ethnic group (women having better OS). When divided by menopausal status, postmenopausal women with LS and ES had worse OS than premenopausal women (14.7 vs. 22 months, HR: 1.50, 95% CI 1.44-1.56; 6.1 vs. 9.8 months, HR: 1.41, 95% CI: 1.37-1.46, respectively). We also observed worse OS in older men when divided by age (<55 years and ≥55 years). In multivariable analysis, older age, postmenopausal status, and Medicaid as primary insurance were associated with worse OS for both LS and ES.

      Conclusion

      In this large cohort, women with SCLC had better OS compared to men. Post-menopausal women had worse OS compared to pre-menopausal women. Since older men had a similar trend of worse survival compared to younger men, age might exert a more significant influence on survival than hormonal status in SCLC. Further studies with data on sexual hormone levels are necessary to better understand their role in women with SCLC.

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    P2.04 - Immuno-oncology (ID 167)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Immuno-oncology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.04-66 - Immunotherapy for All? Representation of Minorities and the Elderly in Lung Cancer Immunotherapy Trials (ID 2047)

      10:15 - 18:15  |  Author(s): Narjust Duma

      • Abstract

      Background

      Minority groups have been historically underrepresented in oncology clinical trials (CT). Disparities also exist among patients with lung cancer (LC), with Black males having the highest mortality rates of all subgroups. In 2015 the first immune checkpoint inhibitor was FDA approved for the treatment of LC, since then these agents have become a cornerstone of LC treatment. We aimed to determine the representation of ethnic minorities and elderly patients in immunotherapy LC trials.

      Method

      Enrollment data from therapeutic immunotherapy LC trials with published results in ClinicalTrials.gov or individual trial publications from 2008 to 2019 was analyzed. Clinical trials that were terminated early or those that did not report race/ethnicity were excluded. Enrollment fraction (EF) was calculated as the number of trial enrollees divided by the 2015 SEER LC prevalence.

      Result

      We identified 29 CT of which 22 (76%) reported race/ethnicity with a total of 11,149 CT enrollees. Majority of CT were phase 3 (54%), international trials (95%), for advanced stage NSCLC (82%). Distribution by sex, age, race/ethnicity and comparison with LC prevalence and US census are described in table 1. Clinical trials participation varied significantly across ethnic groups, Whites (EF 2.4%) and Asians (EF 12.4%) were more likely to be enrolled compared to Blacks (EF 0.46%) and Hispanics (EF 0.85%). Younger patients (<65 years-old) were more likely to be enrolled when compared to older adults, despite the national median age of LC diagnosis being 70 years-old.

      table.png

      Conclusion

      Minority and elderly patients were less likely to be enrolled in immunotherapy LC trials from 2008 to 2019. The underrepresentation of these groups leaves knowledge gaps regarding their response and tolerability to immunotherapy, leading to the extrapolation of data from other populations to treat minority and elderly patients. Future CT should take measures to recruit participants that adequately represent our LC population and increase minority recruitment.

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    PC01 - Reinventing Clinical Trials (ID 83)

    • Event: WCLC 2019
    • Type: Pro-Con Session
    • Track: Advocacy
    • Presentations: 1
    • Now Available
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      PC01.05 - Representation of Minorities and Women in Oncology Clinical Trials (Now Available) (ID 4059)

      11:00 - 12:30  |  Presenting Author(s): Narjust Duma

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    WS06 - Women in Thoracic Oncology Networking Event (ID 355)

    • Event: WCLC 2019
    • Type: Workshop
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 2
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      WS06.01 - Welcome (ID 3828)

      07:00 - 08:00  |  Presenting Author(s): Narjust Duma

      • Abstract

      Abstract not provided

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      WS06.07 - Networking Table 5: Social Media and Networking (ID 4069)

      07:00 - 08:00  |  Presenting Author(s): Narjust Duma

      • Abstract

      Abstract not provided