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Phillip Blanchette
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EP1.14 - Targeted Therapy (ID 204)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Targeted Therapy
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.14-07 - Efficacy and Safety of ALK Inhibitors in ALK-Rearranged Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis (Now Available) (ID 785)
08:00 - 18:00 | Author(s): Phillip Blanchette
- Abstract
Background
First and second generation ALK inhibitors were shown to delay disease progression and improve tumour response in ALK-rearranged advanced non-small cell lung cancer (NSCLC) patients. While a significant progression free survival (PFS) improvement has been consistently reported, no overall survival (OS) benefit was shown in randomized trials. We conducted a systematic review and meta-analysis to assess the efficacy and safety of ALK inhibitors compared to chemotherapy (ALK vs. chemo) and 2nd generation ALK inhibitors compared to 1st generation ALK inhibitors (ALK 2G vs. ALK 1G).
Method
The electronic databases PubMed and EMBASE, were searched for relevant randomized trials. Pooled hazard ratios (HR) for overall survival (OS) and progression free survival (PFS), and pooled risk ratios for objective response rates (ORR) and grade 3 or higher toxicity were meta-analyzed using the generic inverse variance and the Mantel-Haenszel methods. To account for between-studies heterogeneity, random-effect models were used. Subgroup analyses compared PFS by gender, smoking status, brain metastases, race and age.
Result
Six trials were included in the analysis of ALK vs. chemo and four in the analysis of ALK 2G vs. ALK 1G. Treatment with ALK inhibitors improved OS compared to chemotherapy (HR: 0.84, 95%CI 0.72-0.97) while a trend toward a better OS was seen with ALK 2G vs. ALK 1G without reaching statistical significance (HR: 0.64, 95%CI 0.36-1.16). PFS was improved with ALK vs. chemo and ALK 2G vs. ALK 1G (HR: 0.44, 95%CI 0.35-0.44 and HR: 0.38, 95%CI-0.29-0.51, respectively). Similarly, ORR was improved with ALK vs. chemo and ALK 2G vs. ALK 1G (RR: 2.68, 95%CI 1.89-3.81 and RR: 1.16, 95%CI 1.08-1.24, respectively). The risk of grade 3 or higher toxicity did not differ between treatments (RR 1.08, 95%CI 0.88-1.33 and RR 0.77, 95%CI 0.56-1.06, respectively). Overall the PFS benefit of ALK vs. chemo and ALK 2G vs. ALK 1G was homogenous across all subgroups with a greater degree of benefit within never-smokers when treated with ALK vs. chemo (p for subgroup differences=0.03).
Conclusion
This meta-analysis is the first, to our knowledge, to report an OS improvement with the use of ALK vs. chemo. A trend toward a better OS was also seen with ALK 2G vs. ALK 1G and this is likely because of crossover effects and limited OS follow-up. Longer follow up and further research are warranted to directly compare ALK inhibitor sequences and to understand the outcomes of 2nd generation ALK inhibitors as initial therapy.
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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
- Moderators:Diego Signorelli, Juergen Wolf
- Coordinates: 9/09/2019, 15:45 - 17:15, Hilton Head (1978)
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MA14.11 - CareTrack: An Application-Based Method of Documentation for Improving Patient Communication in Cancer Care (Now Available) (ID 1933)
15:45 - 17:15 | Author(s): Phillip Blanchette
- Abstract
- Presentation
Background
Patients being able to accurately understand and recall medical information correctly has been shown to improve outcomes, however, most studies suggest that patient information understanding in oncology tends to be poor with as much as 40-80% of information being relayed by healthcare professionals being forgotten (Kessels, 2003).
Method
Our study aimed to implement the use of ‘CareTrack’, an easy-to-use iPad application, as a simple yet complete app-based information package that provides an appointment summary sheet with no identifying information for patients to take home. An iPad pre-loaded with the CareTrack application was provided to oncologists and they filled in the form for their patients at the end of the initial consultation for lung cancer. A hard printout copy was provided to the patient to take home and the option of an email copy was sent as well. Approximately one-week later a patient satisfaction questionnaire was administered over the phone to patients who participated in the study.
Result
Six oncologists were recruited to the study with 35 patients consented to the study and 25 of these patients completing the follow-up surveys. Our primary objective was to assess feasibility of the CareTrack application. The average physician time to complete the CareTrack form for each patient was 1 minute and 29 seconds thus demonstrating that this is a quick and easy tool for physician use. Our secondary objective was to assess patient satisfaction with a brief survey. Ninety-six percent (24/25) of patients found the CareTrack information provided useful and 100% (25/25) of patients found the information easy to understand. Most patients did not require frequent review of the CareTrack form (28%, 7/25) nor needed the form to remember the information (56%, 14/25) or when discussing diagnosis/stage/treatment at home (44%, 11/25). Importantly, 96% (24/25) of patients were comfortable seeing their cancer information and treatment plan displayed on the CareTrack tool and 84% (21/25) of patients would like to receive additional CareTrack information in the future if their staging and/or treatment planned is changed/updated.
Conclusion
To conclude, the CareTrack application was found to be easy to use and was able to effectively provide new lung cancer patients with a comprehensive yet easy-to-understand summary of their initial consult. In the future, we envision this project expanding province- and nation-wide as well as expanding to other disease sites (e.g. breast, colorectal etc.).
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