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iain Phillips
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EP1.17 - Treatment of Early Stage/Localized Disease (ID 207)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.17-18 - Neutrophil Count Is Non-Prognostic in Early Stage Lung Cancer Treated with SABR: Retrospective Analysis from a Single UK Centre Cohort (Now Available) (ID 2718)
08:00 - 18:00 | Author(s): iain Phillips
- Abstract
Background
Stereotactic body radiotherapy (SABR) has become the non-surgical treatment of choice for stage I and II lung cancer patients. The small number of treatment fractions required and the favourable toxicity profile means SABR is being utilised in frailer population groups, who are more likely to have other life-limiting conditions. Elevated neutrophil count has previously been shown to associated with poorer overall survival across all lung cancer stages. However, there is a relative paucity of evidence for this relationship for in early, opposed to locally advanced, disease. We aimed to determine if neutrophil count was associated with poorer outcome in our SABR cohort.
Method
A database was kept of all patients undergoing lung SABR at the Edinburgh Cancer Centre between 2013-2015. Neutrophil counts from up to three months prior to first radiotherapy fraction were obtained from the Scottish Clinical Information Store. Patient outcome data was extracted from the electronic patient records. Statistical analysis was undertaken using Microsoft Excel and SPSS v25.0 (IBM).
Result
One hundred and forty-eight patients were included in the sample. Eight-one patients (54.7%) were female, mean age 74.1 years (s.d. 8.6, range 52-93). Patients were followed-up for a mean of 1.36 years (range 0.17-4.07 years). Full blood counts were available for ninety-six patients. There was no significant difference in neutrophil count between patients who were alive or dead at the end of follow-up: median (interquartile range) 5.40 (3.40-6.40) vs. 6.35 (3.85-8.85), p = 0.657. Neutrophil count was also not associated with progression-free survival: median (interquartile range) 5.41 (4.41-6.41) vs. 5.86 (3.86-7.86), p = 0.835.
Conclusion
Our findings suggest that pre-treatment neutrophil count is non-prognostic in early stage lung cancer treated with SABR. This contrasts with findings from two other single centre series. Our findings may be attributable to the small tumour size in our cohort.
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EP1.18 - Treatment of Locoregional Disease - NSCLC (ID 208)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.18-07 - Evaluation of Patient Outcomes Using Haematological Bio-Markers in Patients Undergoing Chemoradiation for Non Small Cell Lung Cancer (Now Available) (ID 1011)
08:00 - 18:00 | Author(s): iain Phillips
- Abstract
Background
Baseline haematological markers have potential to prognosticate the outcomes of patients undergoing chemoradiation for NSCLC (1)(2). We aimed to evaluate progression free survival (PFS) and overall survival (OS) from all patients with NSCLC receiving radical Cisplatin/Vinorelbine chemoradiation in 2017, based on absolute neutrophil count (ANC) and Neutrophil-Lymphocyte Ratio (NLR).
Method
Patients identified by interrogating the local chemotherapy and radiotherapy prescribing databases. We included all patients whose intended treatment was radical radiotherapy (60Gy/30 fractions over 6 weeks), with 4 cycles of concurrent Cisplatin and Vinorelbine.
We recorded patient and tumour characteristics alongside baseline ANC and NLR. Kaplan Meier Survival Analysis was used to compare Progression Free Survival (PFS) and Overall Survival (OS). Previous studies in locally advanced lung cancer has shown outcome differences comparing groups ANC of 8 and NLR of 5. We used a log rank test to differentiate between these cohorts with a pre-test p value of 0.05.
Result
50 patients were identified. Median age was 64 years old (range 42-78). 56% were male and 44% female. 11 patients (22%) were ECOG performance status (PS) 0, 38 patients (76%) PS 1 and 1 patient (2%) PS 2. No patients were PS 3 or 4.
10 patients(20%) had an ANC<8, 40(80%) had ANC >8 (Range 1.37-20.94). PFS (ANC<8 vs ANC>8, 115 weeks vs 34 weeks, p=0.005) and OS (130 weeks vs 34 weeks, p=0.047).
10 patients (20%) had a NLR>5, 40 (80%) had NLR<5 (Range 0.81-19.39). PFS (NLR <5 vs NLR >5, 101 weeks vs 32 weeks, p=0.053) and OS (130 weeks vs 59 weeks, p=0.132).
Conclusion
The sample selected shows a statistically significant association between baseline neutrophil count and overall survival in patients receiving chemo-radiotherapy for NSCLC. This suggests that these haematological baseline characteristics can help risk stratify patients. Further understanding of NLR is required as the sample showed no statistical significance between the two groups although this may be in part due to relatively small sample size.
References
(1) Schernberg et al (2018). "Neutrophilia as prognostic biomarker in locally advanced stage III lung cancer." PLOS one. 13(10).
(2) Scilla et al (2017). "NLR Is a Prognostic Marker in Patients with Locally Advanced Non-Small Cell Lung Cancer Treated with Combined Modality Therapy." The Oncologist. 22:737–742.
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P2.01 - Advanced NSCLC (ID 159)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 2
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.01-13 - The DAIL Trial: Dietetic Assessment and Intervention in Lung Cancer (ID 552)
10:15 - 18:15 | Author(s): iain Phillips
- Abstract
Background
Clinical Trial in Progress
Lung Cancer related weight loss has a complex aetiology. It includes 3 overlapping but distinct syndromes: cachexia, sarcopenia and malnutrition. ESPEN (European Society for Clinical Nutrition and Metabolism) guidelines suggest that everyone with a new diagnosis of cancer is screened for malnutrition, but there is minimal evidence to support this recommendation.
We have opened the DAIL trial to further investigate the proportion of patients with newly diagnosed Non-Small Cell Lung Cancer (NSCLC) who should be referred to a dietitian, and the proportion of patients who had cachexia, sarcopenia and malnutrition.
Method
Primary objectives are:
1. To identify the proportion of patients diagnosed with NSCLC who are malnourished, cachectic and have sarcopenia before anti-cancer treatment.
2. To identify the proportion of lung cancer patients who would require dietetic review before anti-cancer treatment.
Secondary objectives are:
1. To identify whether malnutrition, cachexia or sarcopenia affects overall survival in metastatic NSCLC.
2. To identify whether sarcopenia predicts for a poor outcome in NSCLC.
In the study we use patient generated questionnaires, physical assessments and radiological tests to define malnutrition, sarcopenia and cachexia.
The specific assessments are:
Patient generated subjective global assessment (PG-SGA)
G8
EORTC QLQC30
EORTC LC13
Performance status
Hand grip strength
Spirometry
Psoas muscle assessment from diagnostic cross sectional imaging
Charlson Co-morbidity Index
Inclusion criteria are:
Patients >18 years old who are able to consent to entry into a clinical trial
Biopsy confirmed Advanced NSCLC (stage IIIb and IV).
Patient receiving first line systemic palliative anti-cancer treatment.
Exclusion criteria are:
Inability to consent to treatment
Patient declines anti-cancer treatment
Result
Section not applicable
Conclusion
It is anticipated that the results will clarify if a nutritional screening tool such as the PG-SGA can identify patients at risk of malnutrition prior to starting anti-cancer treatment, as well as highlight those who require dietetic intervention. It is hoped that this research will inform a randomised clinical trial of dietetic counselling in lung cancer.
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P2.01-25 - TOURIST: Thoracic Umbrella Radiotherapy Study in Stage IV NSCLC: A Phase III Randomized Trial in Development (Now Available) (ID 1024)
10:15 - 18:15 | Author(s): iain Phillips
- Abstract
Background
Non Small Cell Lung Cancer (NSCLC) is the leading cause of cancer mortality throughout the world with an incidence exceeding 1.2 million. 70% of NSCLC patients present with incurable disease with treatment aimed at alleviating symptoms, maintaining / improving quality of life as well as prolonging survival.
In the last decade there have been dramatic changes in systemic therapy (chemotherapy, immunotherapy, Tyrosine kinase Inhibitors (TKIs)). Despite these advances, many patients suffer from lororegional symptomatic relapse. This may benefit from local radiotherapy in addition to other standards of care such as symptom control. Radiotherapy remains widely used in the management of stage IV NSCLC but strategies vary hugely because the data originates from a series of dose fractionations trials in the 1990s when systemic therapy options were limited.
There is therefore limited evidence regarding the use and place of palliative radiotherapy in conjunction with modern systemic treatments and there is a need to assess benefits of advanced radiotherapy techniques in this population. The TOURIST trial aims to establish the utility of palliative thoracic radiotherapy in the primary treatment of stage IV NSCLC.
Method
This is a phase III platform that currently has 2 study arms, to cover the needs of differing patient populations, defined by the use of first line systemic therapy.
Study 1 (PRINCE) Patients receiving first line systemic therapy as standard of care, who have not progressed after 2-4 cycles are randomised 1:1 to either high dose palliative radiotherapy to the thorax, or to no radiotherapy while continuing on their standard systemic therapy. Co-primary endpoints: overall survival, PROMs recorded QOL, with progression free survival and time to next line of therapy, as secondary endpoints.
Study 2 (QUARTZ Lung) Asymptomatic patients unsuitable for standard systemic therapy randomised 1:1 to low dose palliative radiotherapy dose to the thorax or no radiotherapy. Telephone follow up will be used for PROMs data collection to measure QOL improvements.
Stratification factors for both studies will include bulk of thoracic disease, use of advanced radiotherapy techniques and performance status. The TOURIST trial intends to recruit 750 patients and is anticipated to open in 2020.
Result
Section not applicable
Conclusion
Section not applicable
