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Fu Hao
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EP1.12 - Small Cell Lung Cancer/NET (ID 202)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Small Cell Lung Cancer/NET
- Presentations: 2
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.12-02 - SCLC Treatment Uptake and Survival Outcomes: A 2-Year Comparison Between 2 Tertiary Referral Centers in Alberta, Canada (ID 2920)
08:00 - 18:00 | Author(s): Fu Hao
- Abstract
Background
Although the guideline recommend treatment for small cell lung cancer (SCLC) has not changed for several decades, real world evidence on patterns of practice and outcome are scarce. We compared two similar sized cancer care centers in the province of Alberta over a two-year period for experiences with both extensive stage (ES) and limited stage (LS) SCLC diagnoses, treatment and survival outcomes
Method
Retrospective analyses were conducted on the clinical data of SCLC patients retrieved from the Glans-Look Lung Cancer database. All SCLC patients diagnosed between 2015 and 2016 at the Tom Baker Cancer Centre (TBCC), Calgary and Cross Cancer Institute (CCI), Edmonton were included. The characteristics of patients seen at the two institutions were compared using the Fisher Exact test. The overall survival (OS) outcome based on guideline recommended 1st and 2nd line SCLC treatments as well as treatment location was estimated with Kaplan Meier survival analysis and multivariate Cox Proportional Hazard model.
Result
Between 2015 and 2016, 105 SCLC patients were diagnosed at the TBCC, Calgary and 243 at CCI, Edmonton, Alberta. Patient characteristics were similar for both centers. 66% (69/105) of SCLC were ES at TBCC as opposed to 78% (189/243) in CCI (p = 0.024). Overall, treatment uptake rates in TBCC compared to CCI were as follows: 1st SCLC treatment (chemotherapy, surgery, radiotherapy) rate 88% (92/105) versus 86% (208/243), prophylactic cranial irradiation (PCI) 27% (28/105) vs. 37% (89/243) and 2nd line chemo- and or radio-therapy 33% (35/105) vs. 30% (74/243). 6% (2/36) of LS patients at TBCC compared to 28% (15/54) at CCI had surgery ± adjuvant as their 1st treatment. More ES patients at CCI received chemo & thoracic RT (32 vs.19%, 61/189 and 13/69) as well as PCI (31 vs.16%, 58/189 and 11/69) than those at TBCC. OS at CCI versus TBCC was not statistically different for all SCLC patients (11 vs. 10 months, p = 0.217; HR = 1.278, 95% CI: 0.978 -1.671, p = 0.072) nor when we stratified patients by LS or ES.
Conclusion
Despite subtle variation in the uptake of PCI, surgical resection of peripheral LS, management patterns for SCLC patient, including the uptake of second line treatment were consistent between the two geographically separate centers. It is reassuring that similar survival outcomes can be achieved in the real world setting by the adoption of standard practices across a single health administered jurisdiction.
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EP1.12-12 - Factors Associated with Survival Outcomes Among Relapsed SCLC Diagnosed at a Canadian Cancer Centre (ID 2902)
08:00 - 18:00 | Author(s): Fu Hao
- Abstract
Background
The 5-year survival rate for small cell lung cancer (SCLC) is only 7%. This poor survival is partly accounted for by sparse management options for the high proportion of patients developing disease progression or recurrence after their initial treatment (Koinis et al. 2017). Clinical guidelines recommend 2nd line chemotherapy only for SCLC patients who relapse ≥90 days after their 1st line treatments. This study examined factors predicting favorable survival outcomes among relapsed SCLC patients seen at the Tom Taker Cancer Centre, Alberta Canada.
Method
Retrospective analyses were conducted on clinical data of SCLC patients retrieved from the Glans-Look Lung Cancer database. All SCLC patients diagnosed between 2010 and 2016 who completed ≥ 4 cycles of 1st line platin doublets or single-agent etoposide and then relapsed during or after their initial treatments were included. The characteristics of patients relapsing ≥90 versus <90 days were compared using the Fisher Exact test. The overall survival (OS) was estimated using the Kaplan Meier survival and multivariate Cox Proportional Hazard model.
Result
190 SCLC patients were identified, of which 68% were extensive stage (ES), 57% were female, and 98% were smokers (Ex or current), with a median age of 67 at diagnosis. Most patients relapsed in ≥90 days: 57/60 (95%) for Limited stage (LS) and 102/130 (79%) for ES (p = 0.003). 48% of LS and 45% of ES received 2nd line systemic treatment (2L). In ES, receiving 2L cisplatin/etoposide was associated with better survival compared to not receiving 2L (HR=0.426, p=0.016) and having a longer relapse interval (≥90 days) was also associated with better survival (HR=0.539, p=0.015). Stratifying by relapse intervals, receiving 2L was associated with better survival in both the ≥90 (445 vs 286 days, p = 0.049) and <90 days (301 vs 219 days, p = 0.059) strata. In LS, favorable OS was associated with initial thoracic radiation (RT) receipt (HR=0.237, p=0.024) and no distant metastases (DM) at relapse (HR=0.257, p=0.005). Also of note, 83% LS and 21% ES had RT (p < 0.001) and at relapse, 52% LS and 92% ES had distant metastases.
Conclusion
The median OS in relapsed SCLC is low but is at least improved with 2L receipt in relapsed ES patients irrespective of the time to relapse (≥90 or <90 days). Hence, more effective therapy is required for these patients.
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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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P1.16-33 - From a Systematic Review to Real World Evidence: Integrating Gender as a Clinical Risk Factor in NSCLC (ID 2730)
09:45 - 18:00 | Author(s): Fu Hao
- Abstract
Background
Gender-based disparities in NSCLC experience have been widely discussed in the literature. The recognition of gender as a confounder in clinical practice remains uncertain. Confirming its impact on prognosis encourages personalized interventions in an effort to improve survival for NSCLC patients. Since best prevention programs are derived from findings established from multiple-evidence based analysis, the influence of gender on the observed disparities in NSCLC was explored using worldwide evidence and single institute experience. A systematic review was initially carried out to synthesize the evidence on a global scale to confirm the influence of gender-discrepancies in NSCLC incidence rates. Findings were compared and contrasted using a single cancer institute to highlight potential trends related to the different data.
Method
We identified relevant articles published in English using Medline between 1996 and 2016. Pooled standardized-incidence data was analyzed using a semi-parametric longitudinal regression model to estimate changes in NSCLC incidence as a function of time, histology and gender. A heat map was also designed to illustrate the global trend of NSCLC captured in the published articles. Findings of this review were evaluated to confirm the influence of gender on NSCLC trends and outcomes using a single center record. A retrospective analysis was performed using the Glans-Look Database (GLD) for patients diagnosed between 1999 and 2015. The Kaplan-Meier estimator of cumulative survival was conducted to analyze treatment outcomes of patients using SPSS and R. Statistical significance was set at 95% confidence level (p < 0.05).
Result
Our systematic review demonstrated gender-based disparities over time, and the main effect of gender on incidence rates is significant (p=0.01). Visualizing global trends of NSCLC’s histology confirm that women are prone to develop ADC. GLD data verifies the influence of gender, where women were more prone to develop ADC (49%), and the relative changes of its rate over 15 years increased significantly compared to men (58% vs 32%, P<0.02). Survival rates were also predisposed by gender, where female ADC mOS exceeded that of males in overall comparisons (17.6 vs. 12.2, p=0.047).
Conclusion
Our findings serve as a basis to resolve the inherent controversies in the research, and highlight the importance of gender as a clinical risk factor. Therefore, it is important to include gender as a prognostic tool to improve screening programs and promote tailored therapies for better outcomes. Biological, social, or a combination of factors could also influence the differences observed and warrant further investigation.
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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): Fu Hao
- 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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P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.18-04 - Improved Outcome in Female Stage III NSCLC Diagnoses Is Driven by Non-Curative Intent Treatment, and Adenocarcinoma Histology (ID 2113)
10:15 - 18:15 | Author(s): Fu Hao
- Abstract
Background
Biological sex disparities in incidence, molecular alterations and outcome in NSCLC have been well documented in the literature; however, there are no sex-based approaches to diagnosis and treatment in lung cancer. Recognising differences in therapeutic outcome and survival between the biological sexes could help inform clinical research and further personalized interventions in an effort to improve survival for NSCLC patients.
Method
Using the Glans-Look Lung Research (GLR) database, a retrospective analysis was undertaken for Stage III (AJCC 7th edition) NSCLC patients diagnosed between 1999 and 2014. Demographic, clinical, treatment and outcome data were extracted to assess sex-based differences in histology, treatment uptake and survival. Univariate methods, including Kaplan-Meier survival analysis were performed to compare outcomes by sex, histology and treatment-intent.
Result
1040 Stage III NSCLC were identified, median age 69.6 years (IQR 61.3-76.8), 57.9% female, 89.1% ‘ever’ smokers, 34% adenocarcinoma (ADC), 36% squamous cell carcinoma (SCC), 20% ‘other’, 10% unknown. Among female patients ADC is more prevalent (42% vs. 28%, p<0.001), while in SCC patients are more likely to be males (44% vs. 26%, p < 0.001). Males were more likely to receive palliative-intent treatment (44% vs. 37%), while females more likely to receive best supportive care (BSC) (31% vs. 22%), p=0.006. Median overall survival (mOS) for the entire stage III cohort favoured females (14.1 vs. 10.7 months, p=0.001). This trend was also observed across different treatment categories, where female survival significantly exceeded that of males: curative-intent (25.5 vs. 18 months, p=0.035), palliative-intent (9.5 vs. 8.0 months, p = 0.025) and BSC (11.2 vs. 7.2 months, p=0.014). Although no differences in treatment patterns were seen between males and females within ADC or SCC, sex-based disparities in survival were also present within the ADC histology: female ADC mOS exceeded that of males, in overall comparisons (17.6 vs. 12.2 months, p=0.047), within palliative-intent treatment (15.1 vs. 8.0, p=0.008) and BSE (13.2 vs. 3.4, p=0.005), but not in curative-intent combined modality chemo-radiation (26.8 vs. 21.7 months, p =0.972). No differences in mOS, either overall or by treatment category were observed in SCC.
Conclusion
Higher mOS among females in stage III NSCLC appears to be driven by both the ADC histology and non-curative-intent treatments. Sex-based differences in outcomes should be assessed more deeply as prognostic variable in patients with NSCLC.
