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H.S. Winter



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    P1.18 - Poster Session 1 - Pathology (ID 175)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Pathology
    • Presentations: 1
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      P1.18-010 - Running to keep up! The timeline of evolving research in EGFR testing and targeted therapies in New Zealand (ID 1577)

      09:30 - 09:30  |  Author(s): H.S. Winter

      • Abstract

      Background
      The rapid pace of the development of new knowledge that may impact on clinical practice means that the time between scientific developments and their implementation in clinical practice may be short. This makes research work rewarding and exciting, but also much more akin to sprinting than running a marathon. We use a Health Research Council-funded study on the feasibility of introducing EGFR testing into New Zealand for Maori lung cancer patients as an example of the complexity of timelines between research and clinical practice

      Methods
      Aims of this mixed method study included exploring clinicians' and patients’ views on EGFR testing, which was not routinely available in New Zealand at that time.

      Results
      Between the time of the research proposal being written and the 12-month study completed and findings published, the landscape changed dramatically, with an emerging national focus on access to both EGFR testing and tyrosine kinase inhibitors. The time line for the project and key findings are presented alongside the evolving research, international and national guidelines for molecular testing and implementation of EGFR testing. We suggest how these developments may influence the implementation of future molecular testing such as ALK testing, which remains sporadic in New Zealand.

      Conclusion
      The translation of scientific discoveries to research findings to clinical practice guidelines is convoluted and complex rather than orderly and sequential. This case of EGFR testing provides lessons for the translation of other scientific discoveries, which may significantly improve the care of lung cancer patients

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    P1.24 - Poster Session 1 - Clinical Care (ID 146)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P1.24-036 - Combined Modality Treatment for inoperable Non-Small Cell Lung Cancer - a retrospective study from a New Zealand regional cancer centre. (ID 2593)

      09:30 - 09:30  |  Author(s): H.S. Winter

      • Abstract

      Background
      Lung cancer in New Zealand is associated with poor survival and regional inequalities. Non-small cell lung cancer (NSCLC) accounts for 80%–85% of all newly diagnosed lung cancer cases. Forty five percent of these patients present with stage III disease (mediastinal node involvement). The Regional Cancer Treatment Service (RCTS), Palmerston North Hospital is using combined modality treatment (CMT) chemotherapy / radiotherapy protocol for inoperable Stage II and Stage III NSCLC since 2006. The chemotherapy regimen employs 3 cycles of Cisplatinum/Vineralbine. This audit reviews the outcomes and side effects of treatment.

      Methods
      This retrospective study comprises patients with a clinical diagnosis of inoperable NSCLC from the RCTS, Palmerston North Hospital database. Patients confirmed to have stage IIIB and/or inoperable stage II and IIIA NSCLC are included. These patients completed treatment based on the RCTS NSCLC CMT guideline from 1[st] July 2005 to 31[st] May 2012. Information was obtained from Oncology electronic records and paper based clinical notes in RCTS. The treatment protocol includes one neoadjuvant cycle of chemotherapy, given 3 weeks prior to commencing of the radiotherapy. It is followed by further two cycles of Cisplatin/Vinorelbine, given concurrently with radical radiation therapy on day 1 and 22 of the radiotherapy. All patients were treated with 3D conformal radiotherapy to total dose is 60Gy in 30 fractions, over 6 to 7 weeks. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 were applied. Progression free survival (PFS) and median survival were estimated and reviewed.

      Results
      From 1[st] of July 2005 to 31[st] of May 2012, 39 patients completed CMT. All cases in the study had a history of smoking. Thirty two (82%) patients had inoperable stage III NSCLC (IIIA - 15 cases, IIIB - 17 cases). The remaining seven patients had stage II disease, (IIA - 3 cases, IIB - 4 cases), who were deemed inoperable due to significant medical problems. Protocol doses were maintained in 79% of patients, with dose reduction typically used due to transient renal impairment, ototoxicity and myelosuppression. Neutropenia (ANC <1000/mm3) was documented in 21% of patients. Six patients (15%) had neutropenia on day 14-15 and 2 patients (5%) on day 22-23. One patient had hospital admission for febrile neutropenia. Five other patients developed neutropenia but remained asymptomatic. Grade III anaemia (Hb <80 g/L) was noted in 6 patients - all of them had 2 units of blood transfusion. There were no treatment related deaths. 23 patients developed progression of the disease. At the time this study is completed, 16 patients are remaining progression free. The median progression free survival is 9.4 months (mean 12.4), with a median overall survival of 16.6 months. This study demonstrated a 3-year survival rate of just below 20 %.

      Conclusion
      These outcomes and toxicities are comparable to the reported international studies and would support continued use of our current protocol. Further studies may be helpful to identify the optimum chemotherapy regimen in concurrent therapy for inoperable NSCLC. The future role of molecular tailored regimens in subgroups of patients undergoing CMT is evolving.