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Stephen Chun
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P1 - Poster Viewing (ID 5)
- Event: NACLC 2019
- Type: Poster Session
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 10/11/2019, 16:45 - 18:00, Exhibit Hall
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P1.20 - Metabolic Responses to Metformin in Early-stage NSCLC Treated With Definitive Radiotherapy: Results of a Phase II Trial (ID 8)
16:45 - 18:00 | Presenting Author(s): Stephen Chun
- Abstract
Background:
Metformin reduces glucose uptake in physiologic tissues and has been shown to affect non-small cell lung cancer (NSCLC) metabolism. We hypothesized that PET-scans could detect the impact of metformin on glucose uptake in NSCLC and we sought to prospectively test this hypothesis in a prospective clinical trial.
Method:
A single-blinded Phase II clinical trial was performed with subjects randomized 6:1 to 3-4 weeks of metformin vs. placebo for inoperable early-stage NSCLC. PET-scans were performed at baseline, mid-treatment (after 2 weeks study medication), and 6 months post-radiation. Stereotactic body radiotherapy (SBRT) to 50 Gy in 4 fractions was used for peripheral tumors and 70 Gy
Results:
There were 14 subjects randomized to the metformin and one to placebo. Histologies were 60% adenocarcinoma, 33.3% squamous cell carcinoma, and 6.7% poorly-differentiated carcinoma. At mid-treatment PET-scan, 57% of subjects randomized to metformin met PERCIST criteria for metabolic response, of which 75% had progressive metabolic disease (PMD) and 25% had partial metabolic response (PMR), whereas the placebo subject had stable metabolic disease (SMD). At 6 months, the metformin arm had 69% complete metabolic response (CMR), 23% PMR and one PMD, and the subject treated with placebo had a CMR. There were no CTCAE grade ? 3 toxicities.
Conclusion:
Majority of subjects treated with metformin had metabolic responses by PERCIST criteria on PET-imaging. Contrary to the effect of metformin on in physiologic tissues, most metabolic responses showed evidence of increased glucose uptake. Further study is needed to understand the mechanistic basis for and the clinical impact of these metabolic responses.
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PD01 - Poster Discussion Session (ID 4)
- Event: NACLC 2019
- Type: Poster Discussion Session
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 10/11/2019, 15:45 - 16:45, Imperial Ballroom (B2 Level)
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PD01.21 - Medicaid Outcome Inequalities in Small Cell Lung Cancer (ID 9)
15:45 - 16:45 | Presenting Author(s): Stephen Chun
- Abstract
Background:
Small cell lung cancer (SCLC) is an aggressive malignancy for which early access to multidisciplinary care is crucial to optimize outcomes. For this reason, insurance coverage such as Medicaid may drive oncologic outcomes in this population. With the Medicaid expansion under the Affordable Care Act, it is meaningful to understand the value of the Medicaid program in disproportionately vulnerable populations such as SCLC.
Method:
Outcomes of SCLC in the United States National Cancer Database (NCDB) were analyzed from 2004-2013 with respect to baseline insurance status. Associations between insurance status and survival were interrogated using univariate analyses (UVA), multivariable analyses (MVA) and propensity score (PS) matching.
Results:
There were 181,784 cases of SCLC of which 38.6% were limited-stage (LS) and 60.2% extensive-stage (ES). In LS-SCLC, Medicaid coverage had similar survival as the uninsured on UVA (HR, 1.02; 95% CI, 0.96-1.08; p = 0.49). MVA showed factors associated with improved survival in LS-SCLC included private/managed care insurance (HR, 0.83; 95% CI 078-0.87; P < 0.001), Medicare insurance (HR 0.92; 95% CI 0.88-0.97; p = 0.002), chemotherapy delivery (HR, 0.62; 95% CI, 0.61-0.64, p < 0.001) and radiation therapy (HR, 142 0.61; 95% CI, 0.60-0.63, p < 0.001). Likewise, Medicaid coverage had no survival advantage in ES-SCLC compared to the uninsured on MVA (HR, 1.00; 95% CI 0.96-1.03, p = 0.78). Factors associated with improved survival in ES-SCLC on MVA included private/managed care (HR, 0.86; 95% CI, 0.83-0.89, p < 0.001), Medicare insurance (HR, 0.94; 95% CI, 0.91-0.97, p < 0.001), treatment at an academic/research program (HR, 0.93; 95% CI, 0.91-0.95; p < 0.001), and chemotherapy delivery (HR 0.40; 95% CI, 0.39-0.40; P < 0.001). After PS matching, median survival was similar between the uninsured and Medicaid groups in both LS-SCLC (14.4 vs. 14.1 months; p = 0.167) and ES-SCLC (6.3 vs 6.4 months; p = 0.918).
Conclusion:
Despite billions of dollars in annual Federal/State funding, Medicaid coverage had no discernable impact on survival in SCLC compared to the uninsured in the United States NCDB. These sobering findings reveal the SCLC population to be a specific healthcare policy target for intervention relevant to the debate on the Medicaid expansion under the Affordable Care Act.
