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S. Kaasa
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P3.07 - Poster Session/ Small Cell Lung Cancer (ID 223)
- Event: WCLC 2015
- Type: Poster
- Track: Small Cell Lung Cancer
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.07-014 - Associations between Comorbidity, Treatment Toxicity and Overall Survival in Limited Disease Small-Cell Lung Cancer (LD-SCLC) (ID 2739)
09:30 - 09:30 | Author(s): S. Kaasa
- Abstract
Background:
Concurrent chemotherapy and thoracic radiotherapy (TRT) is the recommended treatment of LD-SCLC. The treatment often causes severe toxicity. Many patients have comorbidity due to old age and smoking, and it is unclear whether these patients tolerate and benefit from the treatment as much as more fit patients. Studies have shown that comorbidity is a negative prognostic factor in many cancers (including lung cancer), but this has not been investigated in LD-SCLC patients receiving chemo-radiotherapy. We investigated whether comorbidity was a prognostic factor or associated with severe toxicity in a randomized trial comparing two schedules of TRT in LD-SCLC (n=157).
Methods:
Patients received four courses of cisplatin plus etoposide and were randomized to receive concurrent TRT of either 45 Gy/30 fractions (twice daily) or 42 Gy/15 fractions (once daily). Responders were offered prophylactic cranial irradiation of 30 Gy/15 fractions. The Charlson Comorbidity Index (CCI) was used to assess comorbidity from hospital medical records. The CCI rates common conditions associated with increased 1-year mortality with scores of 1, 2, 3 or 6 based on severity - and a total score (“CCI-score”) is calculated. Toxicity was assessed using the CTCAE v3.0. We adjusted for treatment arm and established baseline prognostic factors in lung cancer (gender, stage of disease, appetite loss, weight-loss, age and performance status (PS) in the multivariate analyses.
Results:
157 patients were analyzed (100%). Median age was 63 years, 52% were men, 16% had PS 2, 72% stage III, 30% weight-loss >5% last 3 months and 46% received twice-daily TRT. The most common grade 3-4 toxicities were pneumonitis (n=4; 3%); esophagitis (n=50; 32%) and neutropenic infections (n=64; 41%). 4 patients (3%) died from pneumonitis. 63 patients (40%) had CCI-score 0; 54 (34%) CCI-score 1; 23 (15%) CCI-score 2; 13 (8%) CCI-score 3; 3 (2%) CCI-score 4 and 1 patient had CCI-score 5 (1%). Most common comorbidities were chronic obstructive pulmonary disease (n=60, 38%), peptic ulcer disease (n=19, 12%), previous myocardial infarction (n=17, 11%) and diabetes (n=17, 11%). Median overall survival (OS) for the whole population was 22.7 months. There were no significant associations between CCI-score and median OS in univariate (CCI-score 0: 30.6 months; CCI-score 1: 15.1 months; CCI-score 2: 23.0 months; CCI-score 3: 23.0 months and CCI-score 4-5: 9.3 months, p=0.18) or multivariate analyses (HR: 0.97; 95% CI 0.79 – 1.18, p=0.74). Patients with comorbidity had a shorter survival than others in the univariate (CCI-score 0: 30.6 months, CCI-score ≥1: 18.8 months, p=0.047), but not in the multivariate analysis (HR: 1.27; 95% CI 0.82–1.98, p=0.29). Patients with comorbidity did not experience significantly more grade 3-4 pneumonitis (CCI-score 0: 3%, CCI-score ≥1: 2%, p=1.0), esophagitis (CCI-score 0: 38%, CCI-score ≥1: 28%, p=0.17), neutropenic infections (CCI-score 0: 41%, CCI-score ≥1: 40%, p=0.92) or deaths from pneumonitis (CCI-score 0: 2%, CCI-score ≥1: 3%, p=0.65). There were no other significant associations between CCI-scores and overall survival or toxicity.
Conclusion:
LD-SCLC patients with comorbidity had similar survival and toxicity as others, suggesting that they should be offered similar treatment as those without comorbidity.
