Author of

• 12592

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  P3.10 - Poster Session 3 - Chemotherapy (ID 210)

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

  • 12632

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    P3.10-040 - Optimal Duration of Chemotherapy for Advanced Non-small Cell Lung Cancer. A prospective population-based audit. (ID 2256)

    09:30 - 09:30  |  Author(s): F. Andleeb
    • Abstract

    Background
    Chemotherapy trials for stage IIIB/IV NSCLC have established that 3 cycles was better than 6. International guidelines stipulate 4-6 cycles but recent studies addressing maintenance or switch therapy suggest benefits with prolongation of treatment. Our regional protocol for chemotherapy in stage IIIB/IV NSCLC recommends platinum doublet chemotherapy first line to a total of four cycles with interim CT scan after two to assess response. This audit was undertaken to establish what additional benefit in response was achieved by cycles three and four. Our primary outcomes were response rate to chemotherapy after two cycles and change in response between interim imaging and end of treatment scan after four cycles.

    Methods
    During 2011/2012 all advanced non-small cell lung cancer patients referred for chemotherapy to our regional centre had treatment and outcomes recorded. We excluded from our audit any patients receiving non-first line chemotherapy, oral TKIs or clinical trial agents. We included patients who had received minimum two cycles, recording at baseline: age, gender, pathology, ECOG performance status and chemo regimen. Interim CT scans were classed as stable disease SD, partial response PR, mixed response MR( response at one site of disease with either stable or progressive disease at other sites) or progressive disease PD. CT following four cycles was compared to interim imaging and categorised as stable disease, increased response relative to interim scan, mixed response or progressive disease.

    Results
    188 patients fulfilled audit entry criteria: 96 men, 92 women: age range 36-83 years (median 67y). There were 107 adenocarcinoma (57%), 53 squamous carcinoma (28%) and 21 undifferentiated/ not otherwise specified (11%). ECOG: PS0-1 44%, PS2 6%, PS3 1% but 49% not recorded. Most common chemo regimens were cisplatin/pemetrexed (22%), carboplatin/pemetrexed (20%), gemcitabine/carboplatin (22%) and carboplatin/paclitaxel (14%). After 2 cycles chemotherapy 25 patients (13%) had progressive disease but 66(35%) PR, 72(38%) SD and 15(8%) MR. 25 patients stopped or changed therapy following 2 cycles with a further 25 stopping after 3 cycles. Of the 138 completing 4 cycles 26(19%) had PD on end of treatment scan. 62(45%) had stable disease compared to interim scan and 25(18%) had minor improvement relative to interim scan. Of those showing continuing response most (84%) had had initial PR.

    Conclusion
    Our response rates to chemotherapy after two cycles compare well with published series. Evaluation of interim and end of treatment scans has demonstrated that most of the radiological response to chemotherapy is achieved by the first two cycles. The number of patients responding after 2, if SD at 2, was low and the additional benefit in the minority of PR patients who did continue to respond was marginal. Our audit is limited by lack of quality of life data but if patients experience increased fatigue and toxicity with third and fourth cycles then our data would suggest that early stopping of platinum chemotherapy may not be detrimental to overall response rates. The optimal number of cycles of platinum based chemotherapy remains uncertain and worthy of further research.