Author of

• 12701

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  P3.12 - Poster Session 3 - NSCLC Early Stage (ID 206)

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

  • 12710

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    P3.12-009 - Patterns of care in patients receiving adjuvant chemotherapy for resected non-small cell lung cancer (NSCLC) in South Western Sydney Local Health District (SWSLHD) (ID 2093)

    09:30 - 09:30  |  Author(s): S. Lim
    • Abstract

    Background
    Randomised controlled trials have shown that adjuvant chemotherapy is the standard of care for patients with resected, stages II and IIIA NSCLC. The benefit in stage IB disease remains inconclusive. There are limited data regarding the patterns of care, benefits and toxicities of adjuvant chemotherapy in the non-clinical trial population. We reviewed patterns of care and survival outcomes in patients with resected NSCLC receiving adjuvant chemotherapy.

    Methods
    We retrospectively reviewed medical records for patients with resected, pathologic stages IB-IIIA NSCLC diagnosed between 1/1/2005 and 31/12/2012 in SWSLHD. Patients were identified using an institutional electronic database. Staging was according to the American Joint Commission on Cancer (AJCC) 6[th] edition tumour-node-metastasis (TNM) system. Information was extracted on baseline patient and tumour characteristics, treatment modalities, chemotherapy delivery, treatment-related toxicities and patient outcomes. Survival analysis was performed using Kaplan-Meier method.

    Results
    We identified 137 patients who underwent surgical resection, 63 (46%) received adjuvant chemotherapy and are presented in this analysis. The main reasons that patients did not receive adjuvant chemotherapy included stage IB disease (32%), advanced age/comorbidities (24%), patient preference (14%), prior neoadjuvant treatment (7%) and non referral (7%). The median age at diagnosis was 64 (range 45 - 77) with 57% male, 81% were ex- or current smokers and 80% had an ECOG performance status of 0 or 1. Adenocarcinoma and squamous cell carcinoma histology accounted for 54% and 27%, respectively. Forty one patients (65%) had lobectomy and 22 (35%) had pneumonectomy. Pathological stage was: 1B 5 patients (7.9%), IIA 11 (17.5%), IIB 13 (20.6%) and IIIA 34 (54%). Adjuvant chemotherapy commenced within 90 days of surgery in 94% with a median time to treatment of 60 days (range 25-110). Adjuvant radiotherapy was given to 18 patients (29%), with 52% of patients with N2 disease receiving radiotherapy. Platinum doublet chemotherapy was administered to 62 patients (98%) and cisplatin/vinorelbine was the most common regimen given to 41 patients (65%). The number of planned treatment cycles was completed by 40 patients (63%), and of these, 11 patients (17%) completed all chemotherapy on schedule without dose modification. Eighteen patients (29%) required hospitalisation during treatment. Febrile neutropaenia occurred in 10 (16%), with an additional 24 (38%) developing non-febrile neutropaenia, thrombocytopenia or anaemia. Other clinically significant non-haematological toxicities included: vomiting (11%); renal impairment (10%); ototoxicity (6%); peripheral neuropathy (16%); fatigue (6%); allergy (2%) or myalgias (3%). There were no toxic deaths. With a median follow-up of 18.6 months (range 3.4 to 96 months), 56% had developed recurrent disease with a median disease-free survival of 18.9 months. The majority (94%) developed recurrent disease within 3 years. The median overall survival was 25.6 months. A total of 34 (54%) had died, including 3 non-cancer related deaths.

    Conclusion
    The utilisation of adjuvant chemotherapy rate is moderate but is consistent with other reports. Our results demonstrated a higher rate of febrile neutropenia and shorter median overall survival than the clinical trial population. Therefore, careful selection of patients to undergo adjuvant chemotherapy is essential.