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Ramila Shilpakar
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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: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.01-40 - Outcome of EGFR-Mutated and Non-Mutated Lung Adenocarcinoma Receiving Standard Therapy - A Nepalese Cohort (Now Available) (ID 941)
08:00 - 18:00 | Author(s): Ramila Shilpakar
- Abstract
Background
Lung cancer represents major health challenges worldwide including Nepal where patients (pts) often present in advanced stage. The purpose of this study was to compare the objective response rates (ORR), progression free survival (PFS), and quality of life (QoL) of EGFR-mutated (EGFR-mut) and non-mutated (EGFR-wt) pts with adenocarcinoma of the lung (ACL) receiving standard therapy.
Method
An IRB approved comparative analytical study was performed in pts with ACL. Newly diagnosed stage IV ACL pts were enrolled and ORR, PFS and QoL was compared between EGFR-mut and EGFR-wt (33 pts in each arm) pts. EGFR-mut pts were given gefitinib and EGFR-wt pts were given systemic chemotherapy (pemetrexed/cisplatin or cisplatin/etoposide). Response evaluation was done using RECIST criteria in both arms. PFS was calculated from the date of starting treatment to the date of progression and QoL was evaluated using EORTC QLQ-C30 (version 3) questionnaire and compared between two arms. Adverse effects were assessed using CTCAE criteria. Pts were followed for 1 year.
Result
Complete response (CR) was achieved in 9.1% vs 3.0 % (p=0.46), and ORR was 27.3% vs 15.2% (p=0.23) in EGFR-mut vs EGFR-wt. The median PFS was 11 and 9 months for EGFR-mut and EGFR-wt respectively (p = 0.045). The mean score of global health status from EORTC QLQ-C30 was 68.1 vs 61.6 in EGFR-mut pts vs EGFR-wt pts (p = 0.036). Skin toxicities were more common in pts receiving gefitinib. One pt had grade 3 skin toxicity. Febrile neutropenia and peripheral neuropathy (either grade 1 or grade 2) were the most common toxicities in pts receiving standard chemotherapy.
Conclusion
EGFR-mut pts treated with EGFR-TKI had improved ORR, PFS and QoL in comparison with EGFR-wt pts treated with chemotherapy. EGFR-mutational analysis and EGFR-directed therapy is feasible and provides survival benefit, also in developing countries as Nepal.
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P1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 186)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.16-19 - Understanding Physician Barriers in the Management of Lung Cancer in Nepal. Can Educational Intervention Make a Difference? (Now Available) (ID 776)
09:45 - 18:00 | Presenting Author(s): Ramila Shilpakar
- Abstract
Background
Lung cancer is the leading cause of cancer morbidity and mortality for both men and women in Nepal. A majority of patients present with advanced or metastatic disease and some patients are never referred to an oncologist for further treatment after diagnosis. Many factors contribute to this, but diagnostic delay, lack of prompt referral and nihilistic attitude towards lung cancer seem to be most important. Potentially, a lack of oncology training and exposure contributes to this. Herein, we evaluated the physician related factors contributing to the current scenario of lung cancer treatment in Nepal and whether oncology education could make a difference.
Method
A prospective pilot survey among residents and faculty from 10 medical colleges with Internal Medicine programs across Nepal was performed. A structured, self-administered questionnaire focusing on physician’s behavior, practice, and attitude towards lung cancer was used. The questionnaire was distributed by e-mail to each site and a printed copy given to participants.
Result
74 participants responded to the survey questionnaire. Only 3 out of 10 Internal Medicine programs had a compulsory oncology rotation in their residency program. Multiple factors contributed to delay in diagnosis of lung cancer. 66 participants (91.6%) responded that they gave empirical anti-tubercular drugs(ATT) to patients with a non-resolving consolidative mass before they began evaluation for lung cancer; 22 % deferred CT scan before ATT. Multiple courses of antibiotics was a common practice in 62.5% participants. Misattribution of existing symptoms was common. 83.3% agreed that they treated smokers with respiratory symptoms initially as COPD with no consideration of lung cancer while 72.2% did not consider lung carcinoma in a middle-aged, never-smoker female with non-resolving consolidative mass. A paired t-test was used to analyze the responses among participants with oncology education during their residency with those who did not have an oncology rotation and was statistically significant (p= 0.001). We also discovered that 36.1% of participants don’t refer elderly patients with lung cancer to an oncologist because they think lung cancer treatment is usually futile, toxic and does not help the patient.
Conclusion
Lung cancer remains a neglected disease in Nepal. There is an urgent need to overcome physician related barriers by oncology education for physicians and in training programs for early diagnosis and treatment of lung cancer for potential improvement in survival and quality of life in patients with lung cancers.
