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Dan J Raz
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MA16 - Prioritizing Use of Technology to Improve Survival of Lung Cancer Subgroups and Outcomes with Chemotherapy and Surgery (ID 142)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
- Moderators:Jair Bar, Navneet Singh
- Coordinates: 9/09/2019, 15:45 - 17:15, Interlaken (1988)
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MA16.06 - Deterioration in Health-Related Quality of Life Diminishes Benefit of Lung Cancer Resection in Older Adults (Now Available) (ID 2875)
15:45 - 17:15 | Author(s): Dan J Raz
- Abstract
- Presentation
Background
Outcomes of oncologic resection are related to tumor biology as well as patient-reported health factors. However, data regarding changes in functional status and health-related quality of life (HRQOL) before and after lung surgery are currently lacking.
Method
We identified lung cancer patients from the SEER-Medicare Health Outcomes Survey (MHOS) linked database. HRQOL survey data captured physical/mental health, activities of daily living (ADLs), and medical comorbidities. Patients who underwent surgery with 1) baseline HRQOL survey prior to cancer diagnosis and 2) follow-up survey at least one year after diagnosis were selected. Patient, disease, and HRQOL measures were analyzed using Cox proportional hazards regression in regard to overall survival (OS) and disease-specific survival (DSS).
Result
Overall, 138 patients were evaluated, of whom 67 (49%) were male. Mean age at diagnosis was 74 years. The majority of patients were Caucasian (n=112, 81%). Disease extent was localized for 75 (54%), regional for 58 (42%), and distant for 5 (4%). In general, the cohort experienced a decline in physical HRQOL, mental HRQOL, and ADLs; and an increase in the number of major comorbidities (see Table). Median OS was 74 months. Decreased OS was independently associated with male sex (HR 1.7, p=0.03), more advanced disease (regional vs. localized: HR 1.8; distant vs. localized: HR 2.1; p=0.04), and decline in ADLs (HR 1.8, p=0.02). Decreased DSS was independently associated with male sex (HR 2.2, p=0.03), more advanced disease (regional vs. localized: HR 2.9; distant vs. localized: HR 3.1; p=0.01), and decline in mental HRQOL (OR 2.1, p=0.02).
Conclusion
The potential survival benefit of lung resection for malignancy is diminished by declines in physical and mental health. Among older surgical patients at risk for functional and HRQOL deterioration, identification and mitigation of such deterioration may in turn optimize oncologic outcomes.
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OA13 - Ideal Approach to Lung Resection and Novel Perioperative Therapy (ID 146)
- Event: WCLC 2019
- Type: Oral Session
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:Tomasz Grodzki, Kenji Suzuki
- Coordinates: 9/10/2019, 11:30 - 13:00, Toronto (1985)
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OA13.07 - Neoadjuvant Atezolizumab in Resectable NSCLC Patients: Immunophenotyping Results from the Interim Analysis of the Multicenter Trial LCMC3 (Now Available) (ID 1755)
11:30 - 13:00 | Author(s): Dan J Raz
- Abstract
- Presentation
Background
The immune mechanisms dictating response and resistance to PD-(L)1 blockade are not well understood in early stage non-small cell lung cancer (NSCLC). Understanding these mechanisms will be key to improve outcomes and identify the next generation of predictive biomarkers of response to these therapies. Here, we present updated immunophenotyping at time of interim analysis of LCMC3, a multicenter trial of neoadjuvant atezolizumab in resectable NSCLC (NCT02927301).
Method
Patients received 2 cycles of atezolizumab before resection. Tumor, LN biopsies and PB were obtained pre-atezolizumab and at surgery. Paired PB, screening and surgical LN were analyzed using IMMUNOME flow cytometry. Plasma-based cytokine arrays were performed on a subset of patients. Immunophenotypic analyses were correlated with treatment effect, major pathologic response (MPR, primary endpoint) and preoperative treatment-related adverse events (preop-TRAE).
Result
We report on 55 patients with paired PB samples (analyzed within 72h after collection) and completed surgery. We observed preop-TRAE in 32/55 patients (18 grade 1, 13 grade 2, 1 grade 3). CD1c+ and CD141+ myeloid cells (MC) were lower at baseline in patients developing preop-TRAEs, while monocytic M-MDSCs were higher in those patients. Senescent T cells decreased in patients with preop-TRAE and increased in patients with non-preop-TRAE. After treatment, the absolute cell counts of late activated CD4+and CD8+T cells decreased in patients achieving MPR. LN IMMUNOME data, cytokine data and 12-month follow-up (DFS, OS) will be reported.
Conclusion
Preliminary immunophenotyping data from the interim analysis showed significantly lower baseline immunosuppressive cell subsets in patients with preop-TRAE and decreased late activated CD4+and CD8+T cells from PB in patients with MPR.These results, together with additional LN IMMUNOME and cytokine analyses, may improve our understanding of immunophenotypic features associated with outcome, and changes induced by neoadjuvant atezolizumab in early stage NSCLC patients.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P2.17 - Treatment of Early Stage/Localized Disease (ID 189)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.17-33 - Deterioration in Health-Related Quality of Life Is Associated with Lower Lung Resection Rates in Older Adults (ID 2863)
10:15 - 18:15 | Author(s): Dan J Raz
- Abstract
Background
Decision making for surgical resection of lung cancer is based on disease characteristics as well as patient-reported health factors. However, data regarding influence of functional status and health-related quality of life (HRQOL) on consideration for lung surgery are currently lacking.
Method
We identified lung cancer patients with localized disease from the SEER-Medicare Health Outcomes Survey (MHOS) linked database. HRQOL survey data captured physical/mental health, activities of daily living (ADLs), and medical comorbidities. Patients who had 1) baseline HRQOL survey prior to cancer diagnosis and 2) follow-up survey at least one year after diagnosis were selected. Generalized estimating equation (GEE) model was used to compare patients who underwent surgery versus those who did not in regard to demographics and HRQOL measures.
Result
Overall, 108 patients were evaluated, of whom 75 (69%) underwent surgery. Surgical patients were younger (mean 73 versus 80 years, p<0.0001); otherwise, patient groups were demographically similar. Surgery was not performed based on surgeon recommendation (n=21, 64%), contraindication(s) (n=9, 27%), or patients’ decision (n=3, 9%). Surgery and non-surgery groups experienced similar declines in physical HRQOL, mental HRQOL, and Katz aggregate ADL scores; and an increase in the number of major comorbidities (see Table). However, non-surgical patients had significant declines in specific individual ADLs, namely mobility and personal care activities, compared to surgical counterparts. On GEE, adjusting for age, non-surgical patients were significantly more likely to have decreased physical HRQOL (OR 5.7, p=0.008), mental HRQOL (OR 2.1, p=0.049), or ADL scores (OR 2.7, p=0.02); and multiple comorbidities (OR 2.3, p=0.046) compared to surgical patients.
Conclusion
Patient-reported outcomes reflect patients’ perception of their own health, potentially providing information critical to surgical decision making that is not similarly reflected in other assessment tools. Identification and mitigation of such factors may increase surgeons’ recommendation for lung resection for patients with localized malignancy.
