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Konstantinos Leventakos



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    EP1.15 - Thymoma/Other Thoracic Malignancies (ID 205)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.15-08 - Association of Perioperative Chemotherapy with Survival in Thymic Malignancies (ID 1436)

      08:00 - 18:00  |  Author(s): Konstantinos Leventakos

      • Abstract
      • Slides

      Background

      Patterns of perioperative chemotherapy utilization and its association with survival in thymic malignancies are largely unknown.

      Method

      We queried NCDB from years 2004-2014 and identified 3,788 patients with non-metastatic thymic carcinoma (TC) and thymoma who received surgery. We compared patients who received perioperative chemotherapy to those who didn't and used a Cox proportional hazards model to determine predictors of mortality.

      Result

      764 patients (20%) received chemotherapy: 287(38%) neoadjuvant (NAC), 347(45%) adjuvant (AC), and 130(17%) unspecified. 184(24%) had TC; the rest had thymoma. Patients who didn’t receive chemotherapy (N=3024) had older age (median 62 vs 47, P<0.01) and earlier stage (51% versus 24% stage I-IIA, P<0.01). In multivariable analysis, patients who received AC versus no chemotherapy had a similar overall survival(OS); however, NAC predicted a worse OS. For separate thymoma and TC subsets, median OS did not differ between those who received AC and those who didn’t in either group. AC did not improve OS for patients with R1/R2 margins (114 months, 95%CI 94-NR vs 131 months, 95%CI 118-NR)

      Characteristic

      Hazard ratio for mortality (95% confidence interval) 1

      Age

      1.03 (1.03-1.04)

      Thymoma vs. TC

      0.50 (0.43-0.58)

      Charlson-Deyo score>0

      1.40 (1.21-1.63)

      Chemotherapy

      None

      Adjuvant

      Neoadjuvant

      Unclassified

      1

      1.13 (0.89-1.44)

      1.77 (1.37-2.27)

      1.60 (1.16-2.19)

      Masaoka-Koga Stage

      I-IIA

      IIB

      III

      Unknown/other

      1

      1.08 (0.88-1.34)

      1.59 (1.34-1.90)

      2.71 (2.01-3.65)

      Radiation

      0.78 (0.67-0.91)

      Positive margin

      1.55 (1.33-1.81)

      1Model included sex, academic center, insurance, and race/ethnicity

      tc_surv_plot_stages_chemo_thymic_carcinoma.jpg

      tc_surv_plot_stages_chemo_thymoma.jpg

      Conclusion

      Chemotherapy in the perioperative setting was not associated with improved OS in either TC or thymoma. Prospective controlled studies are needed to determine the role of perioperative chemotherapy in thymic malignancies.

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    P1.06 - Mesothelioma (ID 169)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Mesothelioma
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.06-02 - National Trends in Outcomes in Patients with Malignant Pleural Mesothelioma (ID 1944)

      09:45 - 18:00  |  Author(s): Konstantinos Leventakos

      • Abstract

      Background

      Malignant pleural mesothelioma is an aggressive tumor and is often incurable. We aim to identify national practice patterns and trends in survival in patients with mesothelioma.

      Method

      We queried National Cancer Database from years 2004-2014 to identify adult mesothelioma cases. We collected baseline characteristics were collected and analyzed treatment patterns and survival trends. Multivariable Cox regression models were applied to identify factors associated with survival.

      Result

      Of 11,372 patients 4354 (38%) had epithelioid histology, 1431 (12%) sarcomatoid, 880 (0.7%) biphasic, and 4707 (41%) unspecified. 20% were stage IA, 22% stage IB, 2% stage II, 1% stage IIIA, 31% stage IIIV, and 23% were stage IV. Sarcomatoid histology was associated with worst overall survival (HR 2.2) while epithelioid histology had best survival (referent). Chemotherapy alone was the most common treatment modality (36%). Combined treatment with surgery, radiation, and chemotherapy was associated with best overall survival (HR 0.45) followed by chemotherapy combined with surgery. However, 1 year and 5-year OS remain low at 41.2% and 6.5% respectively. There has been no clinically significant improvement in overall survival from 2004 to 2014.

      Multivariate Cox Regression

      Variable

      Level

      HR (95% CI)

      Age

      Unit=1

      1.018 (1.015-1.020)

      Academic

      No vs Yes

      1.171 (1.124-1.221)

      Charlson Score

      1 vs 0

      1.104 (1.053-1.158)

      2 vs 0

      1.201 (1.109-1.300)

      >=3 vs 0

      1.460 (1.279-1.666)

      Histology

      Biphasic vs Sarcomatoid

      0.737 (0.675-0.805)

      Epithelioid vs Sarcomatoid

      0.460 (0.432-0.491)

      NOS vs Sarcomatoid

      0.552 (0.518-0.587)

      Sex

      Female vs Male

      0.817 (0.779-0.857)

      Year

      Unit=1

      0.984 (0.977-0.990)

      Insurance

      Medicaid vs Private

      1.193 (1.043-1.364)

      Medicare vs Private

      0.993 (0.940-1.048)

      Other/None/Unknown vs Private

      1.038 (0.938-1.148)

      Stage

      IB vs IA

      1.156 (1.088-1.228)

      II vs IA

      1.229 (1.056-1.431)

      IIIA vs IA

      1.442 (1.164-1.788)

      IIIB vs IA

      1.459 (1.379-1.544)

      IV vs IA

      1.801 (1.695-1.913)

      Treatment

      Chemo vs None

      0.613 (0.584-0.643)

      Chemo, Radiation, & Surgery vs None

      0.450 (0.396-0.512)

      Chome & Surgery vs None

      0.468 (0.436-0.504)

      Other vs None

      0.737 (0.682-0.796)

      Surgery vs None

      0.694 (0.638-0.756)

      survival_treatment.jpgmedianos_trend.jpeg

      Conclusion

      Survival outcomes in mesothelioma remain poor. There is a need for more clinical trials using combinatorial approaches to improve outcomes in mesothelioma.

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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
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.16-14 - Effects of an Artificial Intelligence (AI) System on Clinical Trial Enrollment in Lung Cancer (ID 548)

      09:45 - 18:00  |  Presenting Author(s): Konstantinos Leventakos

      • Abstract
      • Slides

      Background

      Clinical trials offer cancer patients access to the latest promising therapies and improve the overall quality and safety of cancer care. However, few patients participate, due in part to the time and effort associated with traditional manual ad hoc screening methods. IBM Watson Health’s Clinical Trials Matching (CTM) is an artificial intelligence (AI) system that employs natural language processing to abstract patient and trial data from unstructured sources and machine learning to match patients to trials. This study compared the clinical trial enrollment rates of lung cancer patients before and after deployment of CTM.

      Method

      CTM was trained for lung cancer and adopted in an academic outpatient oncology clinic using a phased implementation approach beginning July 2018. Clinical trials included ~42 therapeutic, supportive care, and observational trials. Clinical research coordinators validated Watson-derived clinical trial matches on the day prior to patient clinic visits. Oncologists were provided with a list of potentially eligible trials for each patient to facilitate evaluation at point of care. The average monthly enrollment rates for therapeutic trials were compared 6 months before and after CTM deployment. Average enrollment rates per active clinical trial were reported.

      Result

      Clinical trial matches were validated and delivered to lung oncology providers in 69% (1818/2637) of patients’ visits during the 6-month phased implementation. Enrollment of patients in lung cancer therapeutic clinical trials occurred at a rate of 3.83 patients/month after CTM deployment, as compared to 1.83 patients/month prior to CTM deployment; a 109% enrollment increase. When adjusted for the average number of active clinical trials before (30) and after (39) CTM implementation, the enrollment was 0.097 patients/trial using CTM, compared to 0.061 patients/trial using traditional methods; a 58.4% enrollment increase.

      Conclusion

      Use of IBM Watson Health’s Clinical Trials Matching (CTM) system with screening coordinators facilitated an increase in clinical trial enrollment and promoted awareness of clinical trial opportunities within the lung oncology practice.

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    P2.12 - Small Cell Lung Cancer/NET (ID 180)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.12-24 - Underutilization of Surgery for Localized Small Cell Lung Cancer: A Nationwide Analysis (ID 832)

      10:15 - 18:15  |  Author(s): Konstantinos Leventakos

      • Abstract

      Background

      Although surgery has been recommended in node-negative localized small-cell lung cancer (SCLC), utilization has been low (<10%) in the past. Here, we evaluate treatment patterns and outcomes of surgery in localized SCLC over the last decade to determine if routine practice follows the growing literature in support of surgery in localized SCLC.

      Method

      We queried years 2006-2014 of the National Cancer Database, a hospital dataset capturing 70% of incident cancers in the United States, to identify adults with Stage IA to IIA (T1-T2N0M0) SCLC who underwent treatment. Temporal practice patterns and multivariable survival outcomes were assessed.

      Result

      In the cohort of 5877 patients, 2892 (49%) received chemoradiation, 1300 (22%) received surgery with radiation or chemotherapy, 639 (11%) received chemotherapy alone, 628 (11%) received surgery alone, and 418 (7%) received radiation alone. Amongst patients receiving surgery, 1277 (66%) received a lobectomy or pneumonectomy. Likelihood of receiving surgery in combination with radiation or chemotherapy was higher in later years of diagnosis (15% in 2006 vs 25% in 2014, p<0.001). Stage IA was more prevalent in the group that received surgery alone (77%) or surgery with chemotherapy or radiation (75%) compared to chemoradiation (45%), chemotherapy (49%), and radiation (63%).

      Median overall survival was most favorable for surgery with chemotherapy or radiation (51.8 months) followed by surgery alone (33.2 months) compared to chemotherapy + radiation (26.2 months), radiation alone (17.8 months), and chemotherapy alone (11.8 months)(p<0.001). In a multivariable Cox model (Table), surgery with chemotherapy and/or radiation was associated with decreased mortality versus chemoradiation (hazard ratio=0.6, P<0.001).

      Hazard ratio

      95% CI

      Treatment

      Chemoradiation

      Chemotherapy alone

      Radiation alone

      Surgery alone

      Surgery + chemotherapy or radiation

      Ref

      2.1

      1.4

      0.9

      0.6

      1.9-2.3

      1.2-1.6

      0.7-0.9

      0.6-0.7

      Female sex

      0.8

      0.8-0.9

      Stage

      IA

      IB

      IIA

      Ref

      1.1

      1.2

      1-1.2

      1.1-1.3

      *Model also included age, insurance, median income quartile, Charlson comorbidity score, region, and race (not shown)

      sclung_surv_bytrt_figure1_040919.jpg

      Conclusion

      Utilization of surgery in localized SCLC remains low, despite its association with improved survival. Future clinical trials may be needed to establish the best therapeutic strategy for these patients.