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Masami Yamada



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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: 2
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.16-07 - How to Manage Toxicities of EGFR-TKI for Extreme Elderly Lung Cancer Patients: Supportive Care for Patients Aged 85 and Older (ID 328)

      10:15 - 18:15  |  Author(s): Masami Yamada

      • Abstract
      • Slides

      Background

      In Japan, the population of extreme elderly individuals (85 years and older) was 5.75 million in 2018, and the number of elderly lung cancer patients is increasing. Recently, several elderly-specific trials showed that epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) is effective and feasible for elderly patients with EGFR mutation-positive advanced non-small cell lung cancer (NSCLC). Nevertheless, there have been few reports on the efficacy and safety of EGFR-TKI therapy in patients aged 85 years and older with EGFR mutation-positive advanced NSCLC.

      Method

      We analyzed the efficacy and safety of EGFR-TKI therapy in patients with EGFR mutated NSCLC who were 85 years and older treated at our hospital, between 2014 and 2019. We assessed complications, prognosis, and supportive care needs.

      Result

      The median age was 87 years (range, 85-93 years) at last checkup, and only one patient was male. The study population included 12 patients with ECOG performance status 0-1 and all patients had adenocarcinoma. Four patients (33%) were diagnosed with cognitive impairment. Nine patients received gefitinib therapy. Treatment-related deaths were not observed in our analysis. Median progression free survival, overall survival from recent TKI therapy was 11.3 months, and 16.0 months. The response rate and disease control rate were 17%, and 100%. The common adverse events were diarrhea (25%), skin toxicities (25%), and liver dysfunction (25%). One patient (8%) experienced grade 2 EGFR-TKI-related interstitial lung disease. The dose of EGFR-TKI was reduced in 5 patients (42%) and EGFR-TKI therapy was discontinued in 3 patients (25%) due to toxicities, digestive disorders and interstitial lung disease.

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      Conclusion

      EGFR-TKI therapy is tolerable for extreme elderly patients with EGFR mutation-positive advanced NSCLC. Approximately half of the patients required a dose reduction or focused supportive care, but well tolerated and had similar efficacy compared to those of the younger. It is important for elderly patients to be treated with a personalized management plan and integrated supportive care.

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      P2.16-32 - Best Supportive Care for Extreme Elderly Lung Cancer Patients (ID 411)

      10:15 - 18:15  |  Author(s): Masami Yamada

      • Abstract
      • Slides

      Background

      In Japan, the population of extreme elderly individuals (85 years and older) was about 5.8 million in 2018, and the number of extreme elderly lung cancer patients is increasing. Because of their environmental conditions, they often received the best supportive care (BSC) without chemotherapy or definitive therapy.

      Method

      We conducted an IRB-approved retrospective analysis of 34 lung cancer patients aged 85 years and older, who were treated at our institute from 2014 to 2017, and assessed their backgrounds and prognosis.

      Result

      table(抄録用2019.3.25).jpgThe median age was 89 years (range, 85-96 years), and 22 patients were male. Among the patients considered, 11 had adenocarcinoma (3 harboring EGFR mutation), 8 had squamous cell carcinoma, 5 had NSCLC-NOS, 3 had SCLC, and 7 had an unknown cancer type. Fifteen patients were assigned an ECOG good PS of 0-2, and 19 patients a poor PS of 3-4. The main reasons for receiving BSC alone were poor PS (44%), own will (38%) and cognitive-function disorder (18%). In 10 patients, cancer did not metastasize and 15 patients were transferred to the nursing facility. The median overall survival was 5.6 months. According to univariate analysis (Cox proportional analysis), absence of metastatic disease [hazard ratio: 0.22, 95% confidence interval [C.I.]: 0.07-0.68], PS 0-2 [hazard ratio: 0.11, 95% C.I.: 0.04-0.34], good cognitive function [hazard ratio: 0.35, 95% C.I.: 0.14-0.89], good nutrition (serum albumin ≥ 3.5 g/dL) [hazard ratio: 0.09, 95% C.I.: 0.02-0.41] and plasma C reactive protein(CRP) ≤ 10 mg/L [hazard ratio: 0.27, 95% C.I.: 0.08-0.92] were associated with significantly longer overall survival. Median overall survival of patients with and without metastasis were 1.8 months and 19.7 months, respectively. Patients without metastasis tended to have good PS and had lesser hypoalbuminemia. Most of the patients without metastasis received BSC alone, of their own will.

      Conclusion

      In extreme elderly lung cancer patients, BSC alone had often been selected for reasons other than the disease condition. It is important to construct a palliative treatment strategy based on medical and social characteristics of extreme elderly individuals.

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