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Mark Doherty
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FP02 - Health Services Research/Health Economics (ID 120)
- Event: WCLC 2020
- Type: Posters (Featured)
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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FP02.10 - Predictors of Moderate-to-Severe Symptoms in Stage IV NSCLC: A Population-Based Study of Patient Reported Outcomes (ID 3525)
00:00 - 00:00 | Author(s): Mark Doherty
- Abstract
- Presentation
Introduction
Patients with metastatic NSCLC have significant disease and treatment-related morbidity. In Ontario, Canada, cancer patients complete Edmonton Symptom Assessment System (ESAS) questionnaires, a tool that elicits patients’ self-reported severity of common cancer-associated symptoms at clinical encounters. ESAS domains are: anxiety, depression, drowsiness, appetite, nausea, pain, shortness of breath, tiredness and well-being. The purpose of this study is to examine moderate-to-severe symptom burden in the 12 months following a diagnosis of stage IV NSCLC.
Methods
Using administrative databases and unique encoded identifiers, stage IV NSCLC diagnosed between January 2007 and September 2018 were evaluated for symptom screening with ESAS in the 12 months following diagnosis. Proportion of patients reporting moderate-to-severe score (i.e. ESAS ≥4) in each domain within 12 months were calculated. Patients reporting moderate-to-severe within the different ESAS domains of were plotted over time. Multivariable (MV) Poisson regression models with potential covariates such as age, sex, Elixhauser comorbidity index, socioeconomic factors, and cumulative cancer treatments received were constructed to identify factors associated with moderate-to-severe symptoms.
Results
Of the 22,799 stage IV NSCLC patients identified, 13,593 (59.6%) had at least 1 completed ESAS recorded (87,791 unique assessments) in the year following diagnosis. Majority (94.6%) reported at least 1 moderate-to-severe score. Tiredness (peak: 67.4%, overall: 84.3%), lack of wellbeing (peak: 62.1%, overall: 80.9%), low appetite (peak: 50.4%, overall: 72.1%), and shortness of breath (peak: 51.0%, overall: 68.1%) were the most prevalent moderate-to-severe symptoms reported by patients within 12 months after diagnosis (these peaked at diagnosis), while nausea (34.92%) was the least common.
Conclusion
Patients receiving chemotherapy alone (17.5%, n= 2,380), radiotherapy alone (36.3%, n=4,936), or both (24.8%, n=3,369) reported more moderate-to-severe symptoms compared to patients receiving no treatment (risk ratio [RR]: 1.04, 1.04, and 1.06 respectively [all p-values<0.0001). Receiving chemotherapy alone or chemotherapy and radiotherapy combinations was associated with score≥4 in all individual ESAS domains (p-values <0.05), while receiving radiotherapy alone was associated with score≥4 in all domains but shortness of breath (RR: 0.98, p=0.26). Immigrants and patients with worst socioeconomic deprivation index were less likely to report moderate-to-severe symptoms.
Moderate-to-severe symptoms were prevalent throughout the first year following stage IV NSCLC diagnosis at the population-level. Patients receiving chemotherapy and/or radiotherapy were at increased risk of moderate-to-severe symptoms and may require more supportive care. Further analyses on predictors of severe-to-moderate score on each ESAS domain will be discussed in the presentation.
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MA04 - Health Policy and the Real World (ID 217)
- Event: WCLC 2020
- Type: Mini Oral
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/29/2021, 16:45 - 17:45, Scientific Program Auditorium
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MA04.10 - Discussant (ID 4195)
16:45 - 17:45 | Presenting Author(s): Mark Doherty
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P52 - Staging - Prognosis and Staging (ID 186)
- Event: WCLC 2020
- Type: Posters
- Track: Staging
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P52.03 - Concordance of PET Scan and EBUS-TBNA for Mediastinal Staging of Stage 3 Non-Small Cell Lung Cancer (ID 1593)
00:00 - 00:00 | Author(s): Mark Doherty
- Abstract
Introduction
Mediastinal staging is essential to plan adequate treatment for patients with stage 3 non-small cell lung cancer (NSCLC). Curative-intent radiation fields are often planned based on positron-emission tomography (PET) scan results, despite the fact that this imaging modality has limitations. Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has been shown to have higher sensitivity and specificity. The objective of this study is to evaluate the concordance of PET scan and EBUS-TBNA in mediastinal staging.
Methods
We conducted a retrospective cohort study of patients diagnosed with NSCLC at Sunnybrook Health Sciences Centre, Toronto, Canada, between September 2017 and November 2019. From an institutional database of all lung cancer patients who underwent EBUS-TBNA for lung cancer, patients with stage 3 NSCLC with both EBUS-TBNA and PET scan for mediastinal staging were included. EBUS results were considered the gold standard for nodal staging based on previous publications. Indeterminate PET scan results were reviewed independently by a PET radiologist. Analyses of sensitivity and specificity were conducted on a per-node basis.
Results
Thirty-two patients were included in the analysis. The median number of nodes biopsied per patient was 3 (range 1- 5). Ten patients (31%) had at least one discordant lymph node station. The sensitivity and specificity of PET scan were 78.7% and 79.3%, respectively. Six positive lymph nodes on PET scan were downstaged by EBUS-TBNA, including a patient who was downstaged from cN2 to pN0. The five patients with false positive results did not have any known inflammatory or infectious disease at the time of the PET study. Ten lymph node metastases in five patients were PET-occult. Two patients were upstaged from cN2 to pN3, and one from cN0 to pN2. The size of PET-occult metastases compared to false positive lymph nodes was not significantly different (p=0.65). Seventeen patients (65%) went on to be treated with concurrent chemoradiation, and 6 had radical-intent radiation only. Other patients were treated with chemotherapy only (n=1), targeted therapy (n=3), or lost to follow-up (n=5).
Conclusion
Our study shows there is clinically significant discordance in the extent of nodal metastases between PET scan and EBUS-TBNA among patients with stage 3 NSCLC. Routine systematic EBUS-TBNA may improve radiation treatment planning by including all affected areas while sparing disease-free lymph nodes. This reinforces the recommendation that patients with high risk of N2 or N3 disease should get mediastinal staging prior to definitive therapy. The impact of discordant results on radiotherapy treatment plans will be reviewed in the next phase of our study.
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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
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P76.94 - Survival Analyses and Molecular Predictors of Outcomes in Patients Treated with Osimertinib for Metastatic NSCLC Harboring EGFR Mutation (ID 3809)
00:00 - 00:00 | Author(s): Mark Doherty
- Abstract
Introduction
Tyrosine kinase inhibitors (TKI) are the cornerstone targeted therapy for metastatic non-small cell lung cancer (NSCLC). This retrospective study was undertaken to investigate the impact of the third generation epidermal growth factor receptor (EGFR)-TKI, Osimertinib, on the two most frequent EGFR mutations, exon 21-L158R and exon 19-deletion, encountered in NSCLC. The primary objective was to evaluate potential differences in overall survival (OS) and disease-free survival (DFS) between patients harboring exon 21-L858R mutation and exon 19 deletion when treated with Osimertinib.
Methods
From January 2010 to December 2018, consecutive patients with metastatic NSCLC-EGFR mutations, treated with Osimertinib 80 mg once daily, were analyzed. Retrospective data was extracted through the electronic medical records located at Sunnybrook Health Sciences Centre. All patients had EGFR mutation positivity by cytology, plasma or tissue sampling.
Results
A total of 56 patients were included. The median age at initial diagnosis was 65 years old (range 27 – 85 years). A similar percentage of 46.42% (n=26) of the patients had an EGFR mutation on exon 21-L858R and on the exon 19-deletion. A total of 7.1% (n=4) had either an uncommon type of EGFR mutation or the location of gene modification was unknown. The majority, 76.7% (n=43), were T790m mutation positive, 8.9% (n=5) were negative, and 14.2% (n=8) had unknown T790m mutation status. For those who had T790m mutation, 46.4% (n=24) were positive by plasma and 28.5% by biopsy. Only 16% (n=9) received Osimertinib in the first-line setting and the majority, 84% (n=47), were treated with Osimertinib as second-line or beyond. 50% (n = 28) of this study cohort had brain metastases.
Among the 56 patients treated with Osimertinib, the median DFS for those who had an EGFR mutation on exon 21-L858R was 15.2 months (95% confidence interval [CI] 11.3 - 19.0 months) and 14.2 months for the exon 19-deletion (95% [CI], 6.0 - 22.4 months); p= 0.25.
The median OS was 52.6 months in the exon 21-L858R group (95% [CI] 35.4 - 69.7 months) and 49.6 months for the exon 19-deletion group (95% [CI], 25.6 - 73.6 months); p= 0.58.
Conclusion
Although lung cancer is a heterogeneous disease with variable responses to EGFR-targeted drugs, our study did not show a difference in OS and DFS between the two most common EGFR mutations treated with Osimertinib. A larger population for further investigation is needed.
