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Michael Snee



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    P2.08 - Oligometastatic NSCLC (ID 172)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Oligometastatic NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.08-01 - Outcomes Following Gamma Knife Radiosurgery for Oligometastatic Brain Metastases in Patients with NSCLC at Leeds Cancer Centre (ID 1856)

      10:15 - 18:15  |  Author(s): Michael Snee

      • Abstract

      Background

      Gamma knife (GK) radiosurgery has increasingly been used for brain metastases from NSCLC in the oligometastatic setting. This study reports outcome results for patients with synchronous brain and new brain metastases from NSCLC at Leeds Cancer Centre (LCC).

      Method

      251 patients, who were treated with GK at LCC from 2009 until 2018 were analysed. Retrospective analysis of notes was performed using electronic patient records.

      Statistical analysis was performed using SPSS. Kaplan-Meier curves were performed to estimate time to intracranial progression, survival from diagnosis of brain metastases, and overall survival.

      Result

      Median age was 65 years (range 33 – 90 years). For patients with new brain metastasis (147 patients), TNM stage at diagnosis was stage I (14 patients), stage II (42 patients), stage IIIA (26 patients) or stage IIIB/IV (65 patients).

      Histology was majority adenocarcinoma (59%), squamous cell carcinoma (16%) or NSCLC NOS (13%).

      Radical thoracic treatment (surgery, chemoradiotherapy or stereotactic ablative radiotherapy) was undertaken for 158 patients. 92% completed radical thoracic treatment. Median survival from diagnosis of brain metastases was 382 days (446 days for those with synchronous brain metastases (48 patients), and 325 days for those with new brain metastases (110 patients)).

      For all patients, median time to intracranial progression after GK was 242 days and overall survival after GK was 293 days.

      For patients with synchronous brain metastases at presentation (104 patients), median time for overall survival from date of diagnosis was 435 days. For all patients without brain metastases at presentation, median time to intracranial progression from date of diagnosis was 305 days and overall survival was 693 days.

      Conclusion

      In conclusion, GK radiosurgery is an effective treatment for brain metastases in NSCLC, providing high rates of local control and improved survival. Beneficial effects are seen in patients with synchronous and new brain metastases, demonstrating its role in a wide subset of patients with advanced NSCLC. Use of GK, in combination with radical thoracic therapy, therefore has the potential to dramatically improve survival in patients who may not have previously been suitable for radical treatment.

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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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      P2.12-01 - Small Cell Lung Cancer (SCLC) Treatment and Survival in the UK: A REAL-Oncology Analysis from the I-O Optimise Initiative (ID 1724)

      10:15 - 18:15  |  Author(s): Michael Snee

      • Abstract
      • Slides

      Background

      Outcomes for patients with extensive disease (ED) SCLC are poor. Treatment options have remained mostly unchanged for several decades. As part of I-O Optimise, a multinational research platform providing insights into the real-world management of lung cancers, clinical characteristics and outcomes of patients with ED-SCLC at Leeds Cancer Centre, UK, are presented.

      Method

      This retrospective cohort study used longitudinal data collected from electronic medical records of adult patients diagnosed with ED-SCLC between January 2007 and August 2017 (follow-up to December 2018). ED was defined as stage IV disease at diagnosis or, where staging was missing, by clinical review using the Veterans Administration Lung Cancer Study Group (VALSG) system. Patients with a concomitant malignant primary tumour or missing data for age or sex were excluded. Distinct lines of therapy (LoTs) were identified using a clinically verified algorithm based on name and date of systemic anti-cancer therapy (SACT) prescribed. Overall survival (OS) was determined using Kaplan–Meier methods.

      Result

      Of 5834 patients diagnosed with lung cancer during the study period, 695 (11.9%) had SCLC. Of 655 patients remaining after study exclusions, 425 (64.9%) had ED-SCLC. Where complete years of data were available (20072016), there was a decrease in the proportion of ED-SCLC diagnoses (from 76.3% to 60.0%). Among patients with ED-SCLC, median age was 69 years (range: 6275) and 50.4% were male; 31.3% had a World Health Organization performance score (PS) of 01, 23.8% had PS2, 21.9% had PS3, and 7.3% had PS4. In total, 272 patients (64.0%) received SACT. Annual rates of treatment were similar between 2007 and 2016. Proportions treated were highest in patients with PS0–1 (87.2%) and lowest in those with PS4 (9.7%). Almost all treated patients (96.7%, n=263) received platinum-based SACT as first LoT; 47 patients (17.3% of treated patients) received a second LoT. Median OS (Q1Q3) for patients with ED-SCLC receiving SACT was 7.2 months (4.310.5) versus 0.7 months (0.31.6) for those not receiving SACT. Median OS was similar for treated patients with PS0–1 and PS2 (7.4 and 7.2 months, respectively).

      Conclusion

      In line with other real-world studies, outcomes for patients presenting with ED-SCLC are poor, especially if untreated. Levels of treatment have not improved over the past decade. Availability of new immune checkpoint inhibitors may provide improved survival for some patients, but additional approaches are urgently needed.

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