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A. Guerin



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    P2.10 - Poster Session 2 - Chemotherapy (ID 207)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P2.10-036 - Overall Survival and Hospitalization Rates in Medicare Patients Diagnosed with Advanced NSCLC Treated With Bevacizumab- Paclitaxel-Carboplatin vs Paclitaxel-Carboplatin: A Retrospective Cohort Study (ID 2419)

      09:30 - 09:30  |  Author(s): A. Guerin

      • Abstract

      Background
      The study aimed to compare overall survival and hospitalization rates for Medicare patients diagnosed with advanced nonsquamous non-small cell lung cancer (NSCLC) and treated with first-line bevacizumab-carboplatin-paclitaxel (BCP) vs. carboplatin-paclitaxel (CP).

      Methods
      Patients aged ≥65years first diagnosed with nonsquamous NSCLC stage IIIB/ IV between 2006 and 2009 and treated with first-line BCP or CP therapy were identified in the SEER-Medicare database that links cancer registry and Medicare claims data from United States. Outcomes were measured from the treatment initiation date to the end of data availability on 12/31/2010 for hospitalizations and 12/31/2011 for survival. Survival and hospitalization rates are reported from Kaplan-Meier analyses over the follow-up period. Bootstrap methodology was used to test treatment groups differences in median time to death and first hospitalization. Age-stratified survival analyses were conducted using age 75 as a cut point. Inpatient utilization rates are also reported per 100 patient-days for each treatment group and compared in terms of incidence rate ratios (IRR) estimated from negative binomial models adjusted for potential confounders.

      Results
      Of 1,706 patients, 592 (34.7%) received BCP and 1,114 (65.3%) received CP by inclusion criteria, while 692 (40.6%) were ≥75 years of age. Patient characteristics were balanced between arms for age, sex, disease stage. The BCP group had fewer pre-treatment comorbidities, greater proportion of adenocarcinoma histology, and differences in ethnicity, SEER region, and income compared to the CP group. The median survival time was 10.5 months in the BCP group vs. 8.4 months in the CP group (2.1 months difference, p=0.0007). The difference in median overall survival favoring BCP over CP groups was 1.3 months for patients aged 65-74 years (p=0.11), and 3.3 months for those aged ≥75years (p=0.006). At 6-months and 1 year of follow-up, survival rates for all subjects were, respectively, 70.3% and 43.8% of BCP patients vs. 60.6% and 37.0% of CP patients. After 1 year of follow-up, 69.5% of BCP vs. 75.1% of CP had ≥ 1 hospital admission. Hospitalization rates were significantly lower for BCP patients (adjusted IRRs: 0.82, p=0.003 and 0.77, p=0.002 for hospital admission and hospitalization days). The difference in median time to first hospitalization was 2.1 months (p <.0001). Additional statistics are presented in the Table. Figure 1

      Conclusion
      In this retrospective analysis of updated SEER-Medicare data, first-line therapy with BCP was associated with longer median survival and reduced hospitalizations compared to CP in patients > 65 years of age.

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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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      P2.22-007 - Survival Advancements In Advanced Non-Small Cell Lung Cancer In The Past 20 Years: A Story of Hope (ID 1671)

      09:30 - 09:30  |  Author(s): A. Guerin

      • Abstract

      Background
      New drug developments in the past decades have improved the prognosis of patients with advanced non-small cell lung cancer (NSCLC). This study aimed to quantify the change in 5-year overall survival of patients ≥65years diagnosed with advanced NSCLC from 1991 to 2009 in United States (US).

      Methods
      Patients aged ≥65years that were first diagnosed with NSCLC stage IIIB/ IV between 1991 and 2009 (n= 83,930) were identified in the Surveillance, Epidemiology and End Results database that collects data from several US cancer registries. Four cohorts were defined based on patients’ diagnosis year: 1991-1995, 1996-2000, 2001-2005 and 2006-2009. For each cohort, median survival time from diagnosis and 6-month, 1-year, and 5-year survival rates were reported. The 5-year hazard of death was compared between cohorts using Cox multivariable regression adjusted for age, sex, tumor ‘s differentiation level, cancer stage and patient’s socio-economic status.

      Results
      The main study results are summarized in the table and figure. Patient characteristics changed over time, with patients in the 2006-2009 vs. 1991-1995 cohorts being older (26.1 vs. 17.5% aged ≥80 years), more patients being females (47.6 vs. 42%) and having stage IV cancer (74.1 vs. 64.7 %) at their first diagnosis. Median survival was 4.03 months for the 1991-1995 cohort and increased to 4.30, 4.62 and 4.98 months for the 1996-2000, 2001-2005 and 2006-2009 cohorts. From the earliest (1991-1995) to the latest (2006-2009) cohort the 6-month and 1-year survival rates have increased by 23% (from 37.4 to 46.0%) and 63% (from 16.6 to 27.0%) respectively. After adjustment for potential confounding factors, the 5-year hazard of death decreased by 11%, 21% and 30% respectively for the patients diagnosed in 1996-2000, 2001-2005 and 2006-2009 vs. those diagnosed in 1991-1995.Figure 1Figure 2

      Conclusion
      The last 20 years witnessed a steady improvement in extending the survival of the patients ≥65years diagnosed with advanced NSCLC.