Author of

• 10743

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  P1.10 - Poster Session 1 - Chemotherapy (ID 204)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10783

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    P1.10-040 - Lung cancer outcomes in an era of more options - Survival analysis from an Asian cancer center (ID 2193)

    09:30 - 09:30  |  Author(s): C. Toh
    • Abstract

    Background
    Lung cancer therapy has changed in the last decade with the advent of EGFR tyrosine kinase inhibitors (TKI) and newer chemotherapeutics such as pemetrexed. Most of these benefits have been limited to lung adenocarcinoma and not other histological subtypes. In addition, this has translated to improved progression free survival benefits but no apparent overall survival benefits in some of the phase III studies conducted. We hypothesized that the benefits seen in these phase III clinical trials would translate to improved overall survival in the wider population of patients (pts) treated in a cancer center.

    Methods
    We conducted a survival analysis of all primary stage 3B/4 lung cancer diagnoses available from a cancer center database between 1 Jan 2000 and 31 Dec 2012. The diagnoses were identified based on ICD-9 162 and ICD-10 C34. Recurrent lung cancers were excluded. Histological classification for analysis was based on the IASLC system. Molecular data from adenocarcinoma (AC) was available with routine testing from 2010. Treatment given in the form of pemetrexed and EGFR TKI was also tracked from the pharmacy system from 2001. Vital status was checked against the National Registry of Births and Deaths as at 31 March 2013. The primary endpoint was overall survival (OS) which was defined from the time of diagnosis till death from any cause or last follow-up and estimated using Kaplan-Meier method. Log-rank test was used to compare survivals. Jointpoint regression models were used for trend analyses.

    Results
    A total of 5320 cases of stage 3B/4 primary lung cancer diagnoses were identified. The cases were predominantly male (65%) and Chinese (81%). The median age at diagnosis and gender distribution among the diagnoses in each year remained stable over time. Non-small cell lung cancer (NSCLC) made up 92% of all diagnoses. NSCLC subtypes were adenocarcinoma (52%), squamous (13%), large cell (2%), and Others (25%). EGFR mutation rate among 708 tested cases was 55%, and ALK translocation rate among 108 tested cases was 9%. The jointpoint regression model identified 2005 as a significant turning point in improvement in median OS. Hence comparing 2001-2005 and 2006-2010, the median OS for the entire cohort improved from 8.0 mths (95% CI, 7.1-8.7) to 9.5 mths (95% CI, 8.9–10.2), p = 0.001. This median OS survival benefit was contributed by OS benefits in AC 10.3 mths (95% CI, 9.3-11.8) vs 13.3 mths (95% CI, 12.1 -14.5). The turning point for improvement for median OS survival coincided with increased usage of EGFR TKI and pemetrexed from 2006 and 2008 respectively.

    Conclusion
    There is median OS benefit in lung cancer treatment outcomes tracked over a decade. This observed benefit is in tandem with the increased use of drugs that have clinical benefit in adenocarcinoma. Unmet needs remain for both small cell lung cancer and other NSCLC subtypes.