Virtual Library
Start Your Search
Kristin A. Higgins
Author of
-
+
P13 - Health Services Research/Health Economics - Misc. Topics (ID 219)
- Event: WCLC 2020
- Type: Posters
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
-
+
P13.03 - The Role of Nurse Practitioners Within Thoracic Radiation Oncology and the Benefit to Patients, Physicians and the Healthcare System (ID 1972)
00:00 - 00:00 | Author(s): Kristin A. Higgins
- Abstract
Introduction
The role of NPs within thoracic radiation oncology has evolved over time. At our National Cancer Institute (NCI) comprehensive center we instituted a nurse practitioner (NP)lead survivorship care model for thoracic radiation oncology in order to standardize follow-up.
Methods
We designed a model to optimize MD availability to see new patients and allow NPs to focus on follow up care. After radiation treatment was completed, patients would transition follow-up care to the thoracic NP, with the thoracic NP clinic occurring simultaneously with the Attending rad onc physician. NP was involved in patient care while on radiation treatment to manage treatment related side effects and other issues. Patients were scheduled for first follow-up to occur about 4-6 weeks after radiation was complete. Surveillance imaging consisting of chest CT w/IV contrast was performed every 3-6 months and other imaging, including PET CT as clinically indicated. All imaging studies were reviewed by Attending physician. If new cancer recurrence was suspected, the patient was scheduled for re-evaluation with Attending. Afterwards patients transitioned to NP led survivorship clinic. Patients were follows for 5 years or until progression that necessitated active treatment.
Surveillance Protocol:
ResultsDisease
Surveillance
Stage I non-small cell lung cancer—medically inoperable
12 weeks post tx CT chest, with CT chest q 4 to 6 months thereafter.
Stage III non-small cell lung cancer treated with chemo-RT followed by immunotherapy
Med onc visit within 2 weeks after completion of radiation.
Rad Onc visit q 6 months with CT chest for 5 years or until disease progression.
Limited stage small cell lung cancer
12 weeks post tx CT chest, with CT chest q 3 to 6 months thereafter.
MRI brain 4 weeks post chemoradiation to assess for prophylactic cranial irradiation.
Brain mets treated with SRS
MRI brain with and without contrast q 3 months for 1 year, then q 6 months.
Palliative radiation treatment
6 weeks post-treatment follow-up to assess for symptom resolution. Imaging as needed.
Over a 2-year period 245 new thoracic consults were seen by thoracic lead team radiation oncology. Lead thoracic NP saw 395 thoracic follow-ups. Attending saw 232 thoracic return visit evaluations.
Patient satisfaction with NP led clinic = between 93-100 % per Press Ganey patient surveys.
Conclusion
This NP lead survivorship care model optimizes MD availability for newly diagnosed patients and allows NPs to fully engage in follow-up care for thoracic patients. This model is feasible within a NCI comprehensive cancer center.
This survivorship paradigm creates a supportive environment for follow up care that leads to high levels of patient satisfaction.
-
+
P48 - Small Cell Lung Cancer/NET - Chemo - IO (ID 236)
- Event: WCLC 2020
- Type: Posters
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
-
+
P48.02 - NRG Oncology/Alliance LU005: Chemoradiation vs. Chemoradiation Plus Atezolizumab in Limited Stage Small Cell Lung Cancer (ID 1267)
00:00 - 00:00 | Presenting Author(s): Kristin A. Higgins
- Abstract
Introduction
Limited stage small cell lung cancer (LS-SCLC) is treated with standard of care platinum/etoposide (EP) and thoracic radiation therapy (TRT) with curative intent, however the majority of patients are not cured and median overall survival is approximately 30 months. Addition of atezolizumab to chemotherapy in extensive stage SCLC has improved progression free and overall survival in a non-curative setting leading to hope that addition of an immune checkpoint inhibitor to standard chemoradiotherapy could benefit LS-SCLC patients. LU005 is a randomized phase II/III trial of standard concurrent chemoradiation with or without atezolizumab for patients with LS-SCLC.
Methods
Patients are randomly assigned in a 1:1 ratio to standard EP chemotherapy with concurrent TRT (45 Gy BID or 66 Gy QD) with or without atezolizumab beginning concurrently with TRT, and continued every 3 weeks for up to 12 months. Eligible patients have LS-SCLC, PS 0-2, adequate organ function, no concerning comorbidities (including no active autoimmune disease) and are eligible for TRT. Patients are randomized prior to their second cycle of EP and thoracic radiation begins with the second overall cycle of chemotherapy (first cycle of study therapy) in both treatment arms. Prophylactic cranial radiation (PCI) is recommended for patients who respond to treatment. The phase II/III primary endpoints are progression free (PFS) and overall survival (OS) respectively. Secondary endpoints include objective response rates, local and distant disease control, and quality of life/patient reported outcomes assessment. Translational science component includes blood and tissue based immune related assays.
Results
This study activated in May 2019. 120 of 506 planned patients have been accrued as of 8/20/2020.
-
+
P76 - Targeted Therapy - Clinically Focused - EGFR (ID 253)
- Event: WCLC 2020
- Type: Posters
- Track: Targeted Therapy - Clinically Focused
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
-
+
P76.05 - Radiotherapy with Concurrent Versus Sequential Osimertinib for Advanced Non-Small Cell Lung Cancer: a Multi-Center Toxicity Analysis (ID 874)
00:00 - 00:00 | Author(s): Kristin A. Higgins
- Abstract
Introduction
The third-generation, irreversible tyrosine kinase inhibitor osimertinib is first-line treatment for advanced non-small cell lung cancer (NSCLC) with mutated epidermal growth factor receptor (EGFR). Pre-clinical studies have shown synergistic anti-tumor activity of osmertinib and radiotherapy. However, the safety of radiotherapy with concurrent osimertinib has not been reported.
Methods
Medical records of all patients with EGFR-mutated NSCLC who received radiotherapy and osimertinib at an academic hospital system were reviewed. Thirty-five patients received 46 courses of radiotherapy while taking osimertinib, and 27 patients received 33 courses of radiotherapy followed by osimertinib; all patients in the latter group began taking osimertinib within 30 days of completing radiotherapy. Patients treated by radiotherapy and osimertinib at unrelated time points of disease progression were excluded. Toxicity grades experienced during radiation treatment (per Common Terminology Criteria for Adverse Events v5.0) were compared between patients who received concurrent versus sequential osimertinib.
Results
This series consists of 40 females and 22 males with advanced lung adenocarcinomas. Radiation treatment was palliative or locally consolidative (96%) in all but 2 patients. There was a trend toward more patients with oligoprogressive disease (P=0.092) and fewer patients with poor performance status (P=0.057) treated by concurrent osimertinib. Grade ≥ 3 toxicities during radiotherapy did not significantly differ between those who received osimertinib concurrently versus sequentially (7% versus 3%, P=0.859). Patients who received concurrent osimertinib had inferior progression-free survival (PFS) (HR 2.62, 95% CI 1.09–6.29, P=0.031) and similar overall survival (HR 1.39, 95% CI 0.40–4.81, P=0.60).
Patient Characteristics
Concurrent (%)
N=35
Sequential (%)
N=27
P
Median age, years
60 (range 40–76)
60 (range 38–80)
0.740
Sex
0.563
· Female
21 (60)
19 (70)
· Male
14 (40)
8 (30)
Smoking status
0.469
· Never
23 (66)
14 (52)
· Former
11 (31)
11 (41)
· Current
1 (3)
2 (7)
ECOG
0.057
· 0
11 (31)
10 (37)
· 1
16 (46)
10 (37)
· 2
8 (23)
2 (7)
· 3
0 (0)
4 (15)
· 4
0 (0)
1 (4)
Oligoprogressive disease
19 (54)
8 (30)
0.092
T classification
0.503
· T1
6 (17)
9 (33)
· T2
16 (46)
11 (41)
· T3
7 (20)
4 (15)
· T4
6 (17)
3 (11)
N classification
0.604
· N0
11 (31)
10 (37)
· N1
4 (11)
1 (4)
· N2
17 (49)
12 (44)
· N3
3 (9)
4 (15)
M classification
0.107
· M0
1 (3)
1 (4)
· M1a
7 (20)
0 (0)
· M1b
4 (11)
4 (15)
· M1c
23 (66)
22 (81)
Primary lung tumor lobe
0.286
· LUL
8 (23)
5 (19)
· LLL
7 (20)
1 (4)
· RUL
11 (31)
14 (52)
· RML
2 (6)
1 (4)
· RLL
7 (20)
6 (22)
EGFR mutation
0.400
· Exon 19 deletion
16 (46)
10 (37)
· L858R
12 (34)
9 (33)
· T790M
12 (34)
6 (22)
· Other
3 (9)
6 (22)
Osimertinib dose per day
0.715
· 80 mg
33 (94)
26 (96)
· 40 mg
2 (6)
1 (4)
Irradiated metastatic sites
0.116
· Lung/mediastinum
8 (23)
0 (0)
· Brain
14 (40)
16 (59)
· C spine
2 (6)
0 (0)
· T spine
2 (6)
2 (7)
· L spine
2 (6)
4 (15)
· Non-spinous bone
13 (37)
9 (33)
· Adrenal gland
1 (3)
0 (0)
· Liver
2 (6)
3 (11)
· Distant lymph node
0 (0)
1 (4)
Median follow-up, months
6 (range 0–27)
5 (range 1–42)
0.426
Conclusion
Treatment with radiotherapy and concurrent osimertinib confers acceptable acute toxicity. This finding is clinically significant, as delaying or holding osimertinib during radiotherapy may adversely impact disease control. The observed PFS benefit of sequential osimertinib is likely driven by selection bias for osimertinib-naїve patients whose disease has not yet been under evolutionary pressure to acquire resistance, compared to those already on osimertinib.
