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A.N. Aggarwal
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P3.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 208)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.01-033 - Comparison of Symptom Score and Bronchoscopy Based Assessment with Conventional CT Based Assessment of Response to Chemotherapy in Lung Cancer (ID 1029)
09:30 - 09:30 | Author(s): A.N. Aggarwal
- Abstract
Background:
Computed tomographic (CT) measurements of primary tumor and/or metastatic sites are commonly used for assessment of objective responses to chemotherapy by RECIST and/or WHO criteria. Decisions regarding continuation/stopping chemotherapy are often also based upon changes in clinical symptoms. There is paucity of published literature on symptom plus bronchoscopy based decision making in routine clinical practice. This study aimed to compare reliability of response evaluation of lung cancer patients undergoing chemotherapy by symptoms, chest radiograph (CXR) and fibreoptic bronchoscopy (FOB) based assessment with conventional CT based assessment.
Methods:
Prospective, non-interventional, comparative analysis study. Treatment naïve patients with lung cancer having atleast one evaluable lesion on FOB and planned for chemotherapy were enrolled over a 1-year period. All assessments were done at baseline and after 3[rd] cycle of chemotherapy. Six symptoms (dyspnea, cough, chest pain, hemoptysis, anorexia and weight loss) on visual analogue scale [VAS] were noted. Respiratory symptom burden (RSB) and Total symptom burden (TSB) were calculated from first four and all six symptoms respectively. CXR responses were assessed as per WHO criteria. Bronchoscopic findings were recorded in a proforma adapted and modified from European Respiratory Society (ERS) classification for tracheobronchial stenosis. Video-recording of all bronchoscopies was preserved for objective review. CT response as per RECIST 1.1 was taken as reference standard and agreements tested using Cohen’s kappa (k) statistic.
Results:
Of 87 patients enrolled, 53 completed ≥3 cycles and were included for final analysis. Mean age was 55 years, majority (81.1%) were males, had advanced/metastatic disease [stage IV 56.6%; IIIB 37.7%] and ECOG performance status of 0-1 (52.8%) or 2 (32.1%). Squamous cell carcinoma (50.9%) and small cell (35.8%) were the commonest histological types. Mean scores of all six individual symptoms, RSB and TSB showed statistically significant improvement after chemotherapy. Mean number as well as distribution of FOB lesions decreased significantly after chemotherapy. CXR response had poor agreement with both FOB based and CT based responses. Changes in RSB and TSB categories had no/minimal agreement with CT based responses. RECIST and WHO criteria had strong agreement (k=0.872) with each other for overall response assessment. Bronchoscopic assessment had minimal agreement with both RECIST (k=0.324) and WHO (k=0.349) criteria based assessment. For differentiating responders (CR+PR) from non-responders (SD+PD), FOB based assessment had weak agreement with both RECIST (k=0.462) and WHO (k=0.501) criteria based assessment. For differentiating disease control (CR+PR+SD) from disease progression (PD), WHO criteria based CT response had perfect agreement (k=1.000) while FOB based assessment had moderate agreement (k=0.629) in comparison to RECIST. Variable combinations of FOB based assessment with symptom based assessment and/or CXR response continued to show only moderate agreement (k=0.600-0.799) with CT based assessment for detecting PD.
Conclusion:
Majority of patients have symptomatic improvement after chemotherapy. However, changes in symptom scores and CXR responses correlate poorly with CT responses. CT scan based assessment by RECIST/WHO criteria remains the reference standard for objective evaluation of response to chemotherapy in lung cancer. Bronchoscopic progression may be used as a surrogate for disease progression if CT assessment is not feasible.
