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C. Pernaut



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    P1.10 - Poster Session 1 - Chemotherapy (ID 204)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P1.10-043 - Doublet combination of platinum with pemetrexed for advanced non-small-cell lung cancer: a retrospective analysis of a single institution (ID 2425)

      09:30 - 09:30  |  Author(s): C. Pernaut

      • Abstract

      Background
      There is no single standard doublet combination of platinum chemotherapy for non-small cell lung cancer (NSCLC). In non-inferiority phase III study, cisplatin/pemetrexed showed a significant improvement in survival in patients with non-squamous histology compare to cisplatin/gemcitabine. Recently, continuation maintenance with pemetrexed after cisplatin/pemetrexed was found to prolong overall survival as well. The objective of this retrospective study was to evaluate the efficacy of pemetrexed in combination with cisplatin or carboplatin for stage IV NSCLC at our institution

      Methods
      We reviewed the medical records of 103 patients with stage IV non squamous NSCLC (between January 2008 and December 2012) treated with pemetrexed in combination with platinum (cisplatin 75 mg/m2 or carboplatin AUC5 on day 1 plus pemetrexed 500 mg/m2 on day 1 every 3 weeks) at our institution. After induction chemotherapy patients received pemetrexed 500 mg/m2 every 3 weeks or best supportive care until disease progression or unacceptable toxicity

      Results
      From 103 patients, 27,2% were female and 72,8% were male. The ECOG was 0-1 in 80% of patients, and the median age was 63 years old. Smoking status was 39,5% current smokers, 48,9% former smokers, 10,4% never smokers and 1% unknown. Histologic type was 66% adenocarcinoma, 27% large-cell carcinoma and 7% non other. EGFR status was 46% wild type, 49% unknown and 5% mutated. The median cycles of doublet combination of platinum with pemetrexed was four cycles (1-8). 77,7% patients received carboplatin and 22,2% cisplatin. Thirty-three patients (32%) received maintenance therapy with pemetrexed. The median cycles of maintenance pemetrexed was four (1-34). The response rate achieved was 52,1% (Complete Response 4,4% + Partial Response 47,7%) and 21,1% stable disease, so 73,2% with clinical benefit. Median time to disease progression was 6,6 months (95% CI 4,8 to 7,6 months) in all patients. The median time to disease progression was 8,1 months (95% CI 5,9 to 9,9 months) in maintenance pemetrexed group and 4,1 months (95% CI 3,1 to 5,1 months) in best supportive care group (p<0,001). Median overall survival was 9,6 months (95% CI 8,1 to 11 months) in all patients. The median overall survival was 12,4 months (95% CI 10,4 to 17,1 months) in maintenance pemetrexed group and 9,1 months (95% CI 8,2 to 11,1 months) in best supportive care group (p=0,005)

      Conclusion
      Doublet combination of platinum with pemetrexed and maintenance pemetrexed is effective achieving good response rates and prolonging overall survival. The schema is feasible in patients with non-squamous NSCLC and we reproduced the data from clinical trials in our daily clinical practice. However, there are some questions remaining as the optimal number of induction cycles and most important which biomarkers factors are predicting benefit from maintenance chemotherapy

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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-044 - Use and comparison of erythropoiesis-stimulating agents (ESAs) for the treatment of chemotherapy-induced anaemia (CIA) in patients with non-small cell lung cancer (NSCLC) (ID 2617)

      09:30 - 09:30  |  Author(s): C. Pernaut

      • Abstract

      Background
      There are limited data on the relative effectiveness of biosimilar ESAs and other available ESAs for the treatment of CIA. In addition, it is unclear whether the most recent recommendations for more conservative use of ESAs to treat CIA are reflected in real-world clinical practice

      Methods
      We analysed 73 patients with NSCLC who were included in a retrospective audit of CIA treatment with ESAs in a large oncology centre in Spain, with patients treated by multiple physicians. The patients were treated for CIA with Binocrit[®] 40,000 IU QW (n=12), Binocrit[®] 30,000 IU QW (n=6), darbepoetin alfa 500 μg Q3W (n=36) or darbepoetin alfa 150 μg QW (n=19). In addition to overall haemoglobin (Hb) outcomes, comparisons were performed according to the different ESA treatments given

      Results
      The mean overall haemoglobin (Hb) at start of ESA treatment was 9.4 g/dL; the mean overall Hb level at the end of treatment was 10.6 g/dL. 36/73 patients (49%) achieved a Hb increase of at least 1 g/dL. There were no significant differences (p>0.05) between the groups in terms of Hb levels at the start of ESA treatment. At the end of treatment, however, the mean Hb level in the group treated with darbepoetin alfa 500 μg Q3W was significantly lower than that in the other three groups (Table). No drug-related adverse events were recorded

      ESA Mean treatment duration (weeks) Mean Hb at start of treatment (g/dL) Mean Hb at end of treatment (g/dL)
      Darbepoetin 150 μg QW 4.16 9.2 11.3
      Darbepoetin 500 μg Q3W 4.59 9.4 10.1
      Binocrit 30,000 IU 3.50 9.4 11.1
      Binocrit 40,000 IU 3.67 9.5 10.7

      Conclusion
      Our data indicate that Hb outcomes in a real-world clinical practice setting are similar for the ESA treatments used with the exception of Darbepoetin 500 μg Q3W, which achieved a significantly lower Hb at the end of treatment. We consider the use of ESAs in our centre to be conservative and safe, and to reflect the most recent change in ESA prescribing information and recommendations for more moderated use in patients with CIA (that is, use the lowest possible dose and duration of treatment necessary to avoid transfusions)