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P. Thomas



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    P2.09 - Poster Session 2 - Combined Modality (ID 213)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P2.09-001 - Phase II study of concurrent chemo-radiotherapy (CRT) with weekly cisplatinum plus oral vinorelbine in fit elderly patients with nonresectable locally advanced non-small-cell lung cancer (NSCLC) assessed by Standardized Geriatric Assessment (RACCOSA, GFPC 08-06 study): interim analysis. (ID 233)

      09:30 - 09:30  |  Author(s): P. Thomas

      • Abstract

      Background
      Few studies are dedicated to elderly patients with unresectable stage IIIA/B. We used a Standardized Geriatric Assessment (SGA) to select fit elderly patients and assess if this population can benefit from standard of care, namely concurrent CRT.

      Methods
      The aim of this multicentric phase II opened-study was to assess CRT in patients older 70 years with locally advanced NSCLC, evaluated as “fit” according to SGA.CRT associated oral vinorelbine (30 mg/m²/week) and IV cisplatinum (30 mg/m²/week) during 6 weeks concurrently with radiotherapy (66 Gy, 33 fractions, 6,5 weeks). Main inclusion criterias were : PS ≤ 1, weight loss < 10%, creatinine clearance ³ 50 ml/mn abreviated, VEMS ³ 40%, PaO2 ³ 60 mm Hg, KCO ³ 60% and patient classified as fit according to SGA. The principal end-point was early treatment tolerance (number of patients with adverse event grade ³ 3 (except nausea and vomiting) or grade 4 for hematologic toxicity and asthenia. Secondary end-points were RECIST response 4 weeks after treatment, quality of life, tolerance, progression-free survival and overall survival. Using a Simon's optimal plan in 2 steps, the total number of patients to be included was 59 with an intermediate analysis after 19 patients. Toxicities and serious adverse events were monitored by an independent peer committee.

      Results
      Interim analysis was done after 23 inclusions in 19 evaluable patients: males 84% , mean age 74.6 (70 to 83) years, 3 patients didn’t end the treatment (1 disease progression, 1 cons-indication for radiotherapy, 1 patient choice). Four patients had adverse event ≥ 3 (except nausea and vomiting) or grade 4 hematologic toxicity and asthenia. Treatment efficacy was: 1 RC, 10 RP, 5 SD, 1 PD. Two patients were not evaluable (1 early death, 1 patient’s refusal to further treatment). The independent peer committee judged that toxicities were acceptable and consistent with what was expected. Study is ongoing with 44 enroled patients currently.

      Conclusion
      The interim analysis of a phase II study of CRT in fit elderly patients with no resecable locally advanced NSCLC assessed by SGA showed an acceptable toxicity. Results will be upgraded for the congress.

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    P2.22 - Poster Session 2 - Epidemiology, Etiology (ID 167)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P2.22-004 - Survival improvement in primary lung cancer patients in a 10-year period: results of the French KBP-2000-CPHG and KBP-2010-CPHG cohorts (ID 1361)

      09:30 - 09:30  |  Author(s): P. Thomas

      • Abstract

      Background
      Due to its high incidence and bad prognosis, lung cancer is a major health problem. In the 2000s, several social and scientific changes (such as decreased smoking, improved diagnosis methods, or the development of new drugs and therapeutic strategies) may have changed the epidemiology and prognosis of this cancer. The objective of the present study was to compare 1-year mortality in adult patients with primary lung cancer at a 10-year interval.

      Methods
      In 2000 and 2010, the French College of General Hospital Respiratory Physicians (CPHG) performed 2 prospective multicenter cohort studies collecting information on all new cases of lung cancer diagnosed histologically or cytologically from 01 January 2000 to 31 December 2000, and from 01 January 2010 to 31 December 2010, and managed in the respiratory department of one of the participating general hospitals. A standardized form was completed for each patient. A steering committee checked recruitment exhaustiveness.

      Results
      137 hospitals in 2000 and 104 hospitals in 2010 included respectively 5667 and 7051 patients. The 2 cohorts represented about 1 in 5 lung cancers diagnosed in France in 2000 and 2010. The characteristics of patients and lung cancer changed during the 10-year period in France. In 2010, compared to 2000, patients were older (mean (SD): 65.5 (11.3) years vs. 64.3 (11.5) years; p<0.0001), more frequently women (24.3% vs. 16.0%; p<0.0001) and more frequently never-smokers (10.9% vs. 7.2%; p<0.0001); they had a lower performance status score (PS) at diagnosis (PS 3 or 4: 12.7% vs. 17.7%; p<0.0001); their tumor was more frequently an adenocarcinoma (45.4% vs. 29.0%; p<0.0001). One-year mortality also changed, decreasing from 61.8% in 2000 to 56.4% in 2010. Multivariate analysis showed that the year of diagnosis was an independent risk-factor for death. Other independent risk-factors were older age, male sex, higher PS, active smoking, and small cell lung cancer (please see the table hereafter).

      Odds ratio 95% CI p-value
      Year of diagnosis
      2000 1 (Ref)
      2010 0.84 0.77-0.91 <0.0001
      Age (years)
      <60 1 (Ref)
      60-75 1.03 0.94-1.13 0.55
      >75 1.53 1.35-1.42 <0.0001
      Sex
      Female 1 (Ref)
      Male 1.28 1.15-1.42 <0.0001
      Smoking status
      Never-smoker 1 (Ref)
      Former-smoker 1.02 0.87-1.19 0.84
      Active-smoker 1.23 1.05-1.44 0.01
      Performance status
      0- Asymptomatic 1 (Ref)
      1- Symptomatic but completely ambulatory 2.45 2.23-2.69 <0.0001
      2- Symptomatic, < 50% in bed 6.49 5.73-7.36 <0.0001
      3- Symptomatic, > 50% in bed 15.2 12.6-18.3 <0.0001
      4- Bedbound 39.0 23.5-64.8 <0.0001
      Small cell lung cancer
      Yes 1 (Ref)
      No 0.83 0.74-0.93 0.002

      Conclusion
      In 10 years, 1-year mortality decreased in patients with primary lung cancer. The improvement in survival was not solely due to epidemiological changes in patient characteristics (age, sex, smoking habits, or PS) and tumor characteristics (histological type) over the 10-year period. This supports the hypothesis of improved management of lung cancer in patients followed up in French general hospitals.