Author of

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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: 1
  • Moderators:
  • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall

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    EP1.12-21 - Treatment Patterns and Prognostic Factors in Small-Cell Lung Cancer Patients in Israel – Real World Analysis of a Health Services Database (ID 769)

    08:00 - 18:00  |  Author(s): Raanan Cohen
    • Abstract
    • Slides

    Background
    

    Small-Cell Lung Cancer (SCLC) is an aggressive smoking-associated malignancy, with rapid growth and early metastatic dissemination that accounts for 10-15% of all lung cancers. Data on current epidemiology and clinical aspects of the disease in Israel are lacking.

    In this observational study, we analyzed treatment patterns and prognostic factors in patients with SCLC in Maccabi Healthcare Services (MHS), a public integrated care organization in Israel.

    Method
    

    Patients with newly diagnosed, histologically confirmed SCLC who initiated systemic anti-cancer treatment between 2011 to 2017 were identified from the MHS cancer registry. Their demographic, clinical and treatment data were retrospectively analyzed.

    Result
    

    235 SCLC patients were identified; 61% male, median age 64 years (IQR: 58, 70), 95% ever smokers, 62% had extensive stage disease (ES), 11% had brain metastases and 60% had 0-1 ECOG performance status (PS), all at treatment initiation.

    First-line treatment was platinum-etoposide regimen for the whole cohort. 107 of 235 patients (46%) continued to 2nd-line therapy and 29 patients (12%) received 3rd-line regimen.

    Median overall survival (OS) for the study population was 11.8 months. Patients with limited stage disease (LS) had a significant longer survival than those with ES (23.5 vs 9.1 months, P<0.001). In a multivariable model for all-cause mortality, males had a HR of 1.59 (95% CI 1.14-2.21, P=0.006) compared to females, and patients with ES had a HR of 4.76 (95% CI 1.37-16.49, P=0.014) compared to LS. Additionally, risk of death increased significantly with ECOG PS at presentation (ECOG PS 2 vs 0-1, HR=1.49 (95% CI 0.93, 2.40), ECOG PS 3-4 vs 0-1, HR=3.29 (95% CI 1.10, 9.84)).

    For LS disease, female sex and concurrent chemo-radiation were associated with significantly longer survival.

    Median survival after initiation of 2^nd line was significantly longer for those re-challenged with platinum-based regimen compared with those switched to topotecan: 9.1(95% CI 6.1-12.1) vs. 4.5 months (95% CI 3.3-5.7), P=0.001. Results were not affected by platinum sensitivity (i.e. interval from end of first-line to beginning of second line ≥3 months). A multivariable model considering 2^nd line patients and incorporating age, sex, stage, PS and brain metastasis at diagnosis confirmed these results.

    Conclusion
    

    Overall survival for SCLC patients in a real world setting was found to be similar to those reported in clinical trials. Extent of disease, sex and PS were significantly associated with prognosis. Re-challenge of platinum-based doublet was associated with longer OS compared to switching to topotecan treatment.

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