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Tania Paytan
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P09 - Health Services Research/Health Economics - Real World Outcomes (ID 121)
- Event: WCLC 2020
- Type: Posters
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P09.24 - Real-World Data in Non-Small Cell Lung Cancer Treated with Checkpoint Inhibitors in a Latin American Institution (ID 2483)
00:00 - 00:00 | Presenting Author(s): Tania Paytan
- Abstract
Introduction
While randomized clinical trials (RCT) are the gold standard to determine the effectiveness of cancer therapy, their strict eligibility criteria do not match the conditions that we see in our clinical practice, especially for non-small cell lung cancer (NSCLC) patients. Real-world data (RWD) provides complementary information on use and clinical outcomes. Here we analyzed real-world outcomes of metastatic NSCLC patients treated with checkpoint inhibitors.
Methods
Retrospective analysis of advanced NSCLC treated with PD-1/PD-L1 inhibitors in a private cancer center at Lima-Peru (Oncosalud-AUNA) from 2015 to 2019. Epidemiological, clinical and pathological data were collected from electronic medical records. Efficacy was evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. The Kaplan-Meier method was used to estimate the survival curves, and the influence of different factors on progression-free survival (PFS) and overall-survival (OS) was determined by the log-rank test. The Cox model was used to calculate the hazard ratios.
Results
82 patients were included. Median age at diagnosis was 65 years (range 38-92y); most patients were males (61%), never smokers (62.2%) and had a status performance of 1 (77.8%) or 2 (14.8%). Adenocarcinoma was the most common histological type (84.1%). PDL1 status was negative or unknown for 61% of patients; between 1 and 49% for 19.5%; and ≥50% for 19.5%. 8 patients were EGFR positive. Patients received a PD-1/PD-L1 inhibitors alone or in combination with chemotherapy in 68.3% and 31.7% of the cases, respectively; in either first (48.8%), second (35.4%) or third/later (15.9%) line of treatment. For the complete cohort, the objective response rate (ORR) was 36.6% an 19.5% of patients achieved stable disease. With a median follow-up time of 18.4 months, median PFS was 5 months and median OS was 10.7 months. Duration of response (DoR) was 17.3 months (95% CI 10.29 – 24.38). The type of response was significantly associated with PFS (p<0.01) and OS (p<0.01) (Fig 1). Age, sex, smoking status, histology, PDL1 expression, EGFR status, line of therapy and use in combination or not with chemotherapy, did not appear to impact OS. Status performance of 2-3 vs 0-1 doubled the chances of dying (HR 2.18; 95%CI [1.10-4.32], p=0.025).
Conclusion
This analysis suggests that OS in real-world patients is similar to that reported in RCT. Likewise, the subset of responders obtains durable benefit. The lack of difference in OS according to the evaluated clinicopathologic characteristics suggests benefit of PD-1 inhibitors in a wide spectrum of multitreated patients with metastatic NSCLC. Results from this study confirm those obtained in RCT and demonstrate their applicability to a Latin American real-world setting.
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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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P76.32 - Real-World Data in Non-Small Cell Lung Cancer with Activating EGFR Mutation Treated with First and Second Generation TKI (ID 1664)
00:00 - 00:00 | Author(s): Tania Paytan
- Abstract
Introduction
EGFR-TKIs have demonstrated durable responses in patients with advanced NSCLC harboring EGFR activating mutations in global trials. This study examined the effectiveness of this intervention in a real-world Latin American setting.
Methods
Retrospective analysis of advanced EGFR mutated NSCLC treated with first or second generation tyrosine kinase inhibitors in a private cancer center at Lima-Peru (AUNA) from 2010 to 2018. Epidemiological, clinical and pathological data were collected from electronic medical records. Survival analysis was calculated with Kaplan-Meier method.
Results
53 patients met the inclusion criteria. Median age at diagnosis was 59 years (range 39-85y); most patients were females (62.3%), never smokers (81.1%) and had a status performance of 0-1 (90.6%). Adenocarcinoma was the most common histological type (94.3%). Metastatic involvement at the start of the TKI corresponded to M1a, b and c in 32.1, 11.3% and 56.6% of cases, respectively. 71.7% of patients received erlotinib and 28.3% afatinib, in either first (77.4%), second (20.8%) or third (1.9%) line of treatment. The objective response rate (ORR) was 73.6% with an additional 15.1% of patients achieving stable disease. With a median follow-up time of 32.4 months, median progression-free survival (PFS) was 12 months and median overall-survival (OS) was 24 months. No significant differences in PFS or OS were found according to line of treatment (first vs second/third), TKI used (erlotinib vs afatinib) or type of mutation (exon 19 deletion vs L858R mutation). Among the 35 patients who had progressed, 41.2, 35.3 and 23.5% exhibited a systemic, oligometastatic or SNC-only pattern of progression, respectively. After progressing, 47.7% of patients continued with the same TKI. For them, second PFS was of 6 months.
Conclusion
Durable responses and prolonged PFS and OS are achieved with first and second generation TKI in EGFR mutated NSCLC from a Peruvian cohort. Results from this study confirm those obtained in randomized clinical trials and demonstrate their applicability to a Latin American real-world setting.
