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Blythe Adamson



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    MA14 - The Adequate MTarget Is Still the Issue (ID 140)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Advanced NSCLC
    • Presentations: 1
    • Now Available
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      MA14.09 - Real-World Survival of Relapsed Compared to De-Novo Stage IV Diagnosis of Advanced Non-Small Cell Lung Cancer (Now Available) (ID 529)

      15:45 - 17:15  |  Author(s): Blythe Adamson

      • Abstract
      • Presentation
      • Slides

      Background

      Differences in tumor biology and cancer therapy in early stage lung cancer may affect overall survival (OS) of patients with relapsed stage IV disease compared to others with de-novo stage IV disease. This study aimed to compare real-world survival of these patients.

      Method

      We selected patients with advanced NSCLC diagnosed between 2011 and 2017, who received at least one line of therapy, from the US Flatiron Health electronic health record-derived database. Patient data was collected through June 2018, providing at least 6 months of follow-up.

      OS was defined as time from advanced or metastatic diagnosis to the event of death, censored at last clinic visit or end of oral therapy. The unadjusted OS of patients was estimated using the Kaplan-Meier method. We fit multivariable Cox proportional hazards models to compare the hazard of death between groups.

      Result

      de-novo vs relapsed image final.jpg

      The study included 30,310 patients with median age of 68.8 years, 46.7% female, and 76.8% non-Hispanic white. We observed 22.8% had relapsed and 77.2% were de-novo stage IV. Relapsed patients had median OS of 15.5 months (95% CI: 14.9-16.2). Patients with de-novo stage IV had median overall survival of 12.0 months (95% CI: 11.7-12.2). The force of mortality among relapsed stage IV patients was 24% lower than the rate of death among de-novo stage IV patients (Hazard Ratio [HR]: 0.76; 95% CI 0.73-0.79; p <0.001), adjusting for age, gender, state, histology, smoking, race/ethnicity, and stratifying by year of diagnosis. Sensitivity analyses of an unadjusted model (HR 0.79, p <0.001) and a sub-group analysis of patients with advanced diagnoses in 2016-2017 (HR 0.74, p <0.001) suggested the results were robust.

      Conclusion

      Among patients with stage IV NSCLC that received at least one treatment, those who relapsed had better OS than those who presented with de-novo stage IV disease. These findings have implications for future clinical trial design.

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    P1.01 - Advanced NSCLC (ID 158)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.01-35 - Real World Characterization of Advanced Non-Small Cell Lung Cancer in Never Smokers (Now Available) (ID 453)

      09:45 - 18:00  |  Author(s): Blythe Adamson

      • Abstract
      • Slides

      Background

      NSCLC in never smokers is vastly different from those with a history of smoking in terms of etiology, driver-mutations and response to immunotherapy. We have previously demonstrated a hereditary contribution in never smokers which is not identified in smokers1. This study compares the real-world survival of NSCLC in never smokers to those with a smoking history by mutation status.

      Method

      The study included patients in the Flatiron Health nationwide electronic health record-derived database who were diagnosed with NSCLC, received biomarker testing results (EGFR, BRAF, ALK, and ROS1), and initiated therapy between 2011-2017 with follow-up through June 2018. Overall survival (OS) of patients by smoking and driver mutation groups was summarized via Kaplan-Meier survival estimates, and compared in the context of a multivariate Cox proportional hazard model adjusted by age at stage IV diagnosis, gender, state of residence, histology, smoking status, and race/ethnicity, stratified by categories of advanced diagnosis date within practices.

      Result

      The study included 30,310 patients with median age of 68.8 years, 46.7% female, 76.8% non-Hispanic white, and 12.6% never smokers. Actionable mutations were reported in 9.0%, differentially as 34.2% in non-smokers and 5.5% in smokers. OS differed by smoking and driver-mutation categories (adjusted and stratified p<0.001). The median OS for patients with wild-type mutation status and history of smoking was 9.6 months, for mutated smokers was 19.4 months (adjusted and stratified hazard ratio [HR] relative to WT smokers 0.65 (95% CI 0.60-0.71)) , for wild-type never-smokers was 15.1 months (0.78 (0.73-0.83) relative to WT smokers), and for mutated never-smokers was 25.5 months (0.52 (0.48-0.58) relative to WT smokers).

      smoking and driver mutation status.jpg

      Conclusion

      Never-smokers with NSCLC survived longer than those with smoking history, in both groups of wild-type and mutation-positive patients. Findings highlight that in patients with NSCLC, a smoking history may have similar effect on hazard of death as actionable mutation status.

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