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Harish Kancharla



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    EP1.01 - Advanced NSCLC (ID 150)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 2
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.01-17 - Predictors of Survival Outcomes with Chemotherapy in Advanced NSCLC Patients with Performance Status 2 and Above and Without Driver Mutation (Now Available) (ID 1287)

      08:00 - 18:00  |  Presenting Author(s): Harish Kancharla

      • Abstract
      • Slides

      Background

      Platinum-based combination chemotherapy is recommended as the standard treatment for patients with advanced non-small-cell lung cancer (NSCLC), but its benefit is limited to patientswith performance status (PS) of 0 or 1. However, it is not clear whether these benefits apply to patients with poor performance status (PS 2 and above) and there are no predictors of outcome to suggest whom to treat .This population accounts for a significant portion (up to 30%) of patients of our practice and some of them have been treated with systemic chemotherapy based on clinician’s discretion.We have analyzed the outcome of these patientswho have been treated with chemotherapy despite poor performance status.

      Method

      We performed a retrospective analysis of patients of advanced NSCLC with poor PS (ECOG PS 2 or more) registered at our lung cancer clinic between January 2016 and December 2017 and treated with systemic chemotherapy. Patients with driver mutations who were treated with first line TKIs were excluded. Hospital case records were reviewed for baseline characteristics, treatment details and outcome data. Patients who haven’t come to the hospital in last 3 months were contacted on phone.

      Result

      A total of 95 patients were found to be eligible for this analysis. Median age was 62 years (30-84 years, including 23(24%) patients 70 years or above. At presentation out of these 95 patients, 63(66%) were smokers,31(32%) had cytological proven pleural/pericardial effusion, 10(10.5%) patients had brain metastasis and 34(35.5%) had extra thoracic metastasis (≥2 sites).Majority(64%) patients had ECOGPS 2 but 36 % had PS 3 or 4 also and 44(46%) had one or more associated comorbidities. The most common chemotherapy regimen used was weekly paclitaxel and carboplatin(57.8%) followed by pemetrexed and carboplatin (16.8%).Majority (64%) patients could complete 4or more cycles of chemotherapy however 15 patients (15.7%) could receive only one cycle and 20(21%) patients even received maintenance chemotherapy. Chemotherapy was interrupted due to poor tolerance in 20(21%) patients and grade ¾ toxicity seen in 22(23%) % patients. At least one point improvement in ECOG PS from baseline was observed in 43 patients (45%) after 4 cycles of chemotherapy. Objective response and disease control rates were 20 % and 48.42% % respectively.Aftera median follows up of 8.6 months, median progression free survival was 6.2 months (95%CI 5-10.33).On univariate analysis ,neutrophil –lymphocytic ratio (<5 vs >5 )and induction regimen (weekly Taxol+Platinum vs rest) were significantly associated(p=0.02 and p= 0.04 respectively) with better median PFS

      Conclusion

      Systemic chemotherapy in modified doses and schedules in advanced NSCLC patients with PS 2 and above is feasible and may be associated with better symptom palliation with clinical benefit and improvement in survival.neutrophil –lymphocytic ratio (<5 vs >5 )and induction regimen (weekly Taxol+Platinum vs rest) are predictors of better median PFS . Further studies addressing this neglected subgroup are indicated.

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      EP1.01-91 - Outcomes with Systemic Chemotherapy with Weekly Regimen in Advanced NSCLC Patients with PS 2 and Above and Without Driver Mutation (Now Available) (ID 1173)

      08:00 - 18:00  |  Presenting Author(s): Harish Kancharla

      • Abstract
      • Slides

      Background

      Platinum-based combination chemotherapy is recommended as the standard treatment for patients with advanced NSCLC, but its benefit is limited to patientswith performance status (PS) of 0 or 1. However, it is not clear whether these benefits apply to patients with poor PS( 2 and above)). These patients have inferior outcomes and have been excluded from clinical trials. We have analyzed the outcome of these patients who have been treated with weekly chemotherapy despite poor performance status.

      Method

      We performed a retrospective analysis of patients of advanced NSCLC with poor PS (ECOG PS 2 or more) registered at our lung cancer clinic between January 2016 and December 2017 and treated with weekly chemotherapy. Patients with driver mutations who were treated with first line TKIs were excluded. Hospital case records were reviewed for baseline characteristics, treatment details and outcome data.

      Result

      A total of 68 patients were found to be eligible for this analysis. Median age was 63.5 years (30-77 years, including 17(25%) patients 70 years or above. At presentation out of these 68 patients, 50(73.5%) were smokers,22(32%) had cytological proven pleural/pericardial effusion, 7(10.2%) patients had brain metastasis and 35(51.5%) had extra thoracic metastasis (≥2 sites). Majority(61%) patients had ECOGPS 2 but 39 % had PS 3 or 4 also and 29(42%) had one or more associated comorbidities. The most common chemotherapy regimen used was weekly paclitaxel and carboplatin(82.8%) followed by single agent paclitaxel(17.8%).Majority (63%) patients could complete 4 or more cycles of chemotherapy however 9 patients (13.2%) could receive only one cycle and 16(23%) patients even received maintenance chemotherapy. Chemotherapy was interrupted due to poor tolerance in 10(14.7%) patients and grade ¾ toxicity seen in 16(23%) % patients. At least one point improvement in ECOG PS from baseline was observed in 33 patients (48.5%) after 4 cycles of chemotherapy and objective response and disease control rates were 23.5 % and 50% % respectively. After a median follows up of 13 months, median progression free survival was 7.3 months.

      Conclusion

      Systemic chemotherapy in modified doses and schedules in advanced NSCLC patients with PS 2 and above is feasible and may be associated with better symptom palliation with clinical benefit and improvement in survival. Further studies addressing this neglected subgroup are indicated.

      Only Active 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 or select "Add to Cart" and proceed to checkout.