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Roxana A Tudor
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P2.14 - Targeted Therapy (ID 183)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Targeted Therapy
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.14-28 - Real-World Management and Outcomes of Uncommon EGFR Mutation-Positive NSCLC Patients at Two Tertiary Canadian Cancer Centres (Now Available) (ID 2782)
10:15 - 18:15 | Author(s): Roxana A Tudor
- Abstract
Background
The evolution of targeted therapies has transformed the management of EGFR–mutation positive NSCLC patients, especially for those with exon 19 deletion and exon 21 (L858R). However, uncommon EGFR-mutation carriers represent a unique group with differential sensitivities and dynamic responses to treatment. We aimed to analyze the demographic profile, management patterns and outcome of these patients.
Method
Data were extracted from the institutional Glans-Look Lung Cancer database. Adult patients diagnosed with uncommon EGFR mutation(s) and treated in the palliative setting during 2010-2017 were included. Demographics and clinical characteristics were reviewed retrospectively (Table 1).
Result
Uncommon EGFR mutations were observed in 38 patients, comprising approximately 10% of all EGFRmut+ NSCLC patients (348) diagnosed and treated in Alberta, Canada (2010-2017). Of the total 38 patients, 63% were female, 60% had a smoking history, and 75% were Canada-born. Dual/-triple mutation positivity was found in 40% of patients. 4/38 patients expired prior to receiving any form of palliative treatment. Upon classifying patients as per TKI treatment, it was found that most received gefitinib (67%) as first line systemic palliative treatment (Table 2). Median OS of the entire cohort was 15.1 months; meanwhile those with complex double/-triple mutations experienced longer mOS of 24.9months vs 11.8months for single uncommon carriers.
Conclusion
This Canadian study supports that uncommon EGFR mutation carriers are infrequent in clinical lung cancer practice. Of note, they represent a unique sub-population amongst EGFRmut+ NSCLC patients, and experience differential sensitivity and varied responses to treatment. We observed favorable responses to EGFR-TKIs in patients with double/-triple uncommon mutations, supporting that these patients may benefit from EGFR-TKIs.
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P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)
- 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: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.16-12 - Treatment Uptake and Outcomes of Elderly Stage III NSCLC Patients: A 15-Year Retrospective Real-World Study (Now Available) (ID 1438)
10:15 - 18:15 | Author(s): Roxana A Tudor
- Abstract
Background
Incidence of non-small cell lung cancer (NSCLC) is highly correlated with age; the age-specific incidence rate of NSCLC in individuals ≥ 75 is nearly double that of patients < 70. Further, nearly one-third of patients diagnosed with NSCLC present with locally advanced (Stage III) disease. This represents an anatomically heterogeneous, frequently non-resectable tumour for which contemporary practice guidelines, based on two decades of clinical trials, recommend concurrent chemoradiotherapy (cCRT) to maximize both local tumor control and survival. Underrepresentation of elderly patients in clinical trials requires the use of real-world populations to assess whether current recommendations and trial-derived survival outcomes are also applicable to this significant and growing age group.
Method
A 15-year population-based retrospective analysis of patients with de novo Stage III (AJCC 7th edition) NSCLC diagnosed between 1999-2014 was conducted. Demographic, clinical characteristics, treatment and outcome data were extracted from the institutional Glans-Look Lung Cancer Database. We defined elderly patients as those ≥ 75 years at diagnosis, and investigated the treatment intent, type, uptake and outcomes among elderly and non-elderly patients.
Result
We identified 1040 patients with a Stage III diagnosis. 333 (32%) were elderly. Treatment patterns differed significantly between elderly patients and non-elderly patients: elderly patients were less significantly likely to receive any form of active treatment (82% vs. 58%), particularly curative-intent treatment (41% vs. 14%), and no elderly patients underwent surgical resection. Median overall survival (mOS) favoured non-elderly patients (13.2 vs. 9.7 months, log-rank p <0.001.) Among elderly patients, receipt of curative-intent treatment was associated with significant improvement in mOS (17.4 months vs. 9.3 months for no active treatment/observation, vs. 8.5 months for palliative-intent treatment, p < 0.001). When receiving curative-intent treatment, specifically cCRT, survival outcomes of elderly patients were not significantly different from those of younger patients (24.5 vs. 21.3 months, p=0.81), and had comparable 5-year survival rates (15.9% and 12.2% respectively).
Conclusion
This real-world population reveals that elderly patients are less likely to receive any, and particularly, curative-intent treatment for their NSCLC diagnosis when compared with a younger cohort. When deemed suitable for a curative-intent regiment of cCRT, elderly patients show comparable outcomes to younger cohorts. This finding reinforces the current guideline recommendations that cCRT is associated with best outcome for non-resectable, locally-advanced NSCLC, even among elderly patients. Further, it supports the critical need for more tolerable and effective treatments for this presentation of disease to improve feasibility of curative-intent treatment for all, but in particular, elderly patients.
