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H. Kishi



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    P2.10 - Poster Session 2 - Chemotherapy (ID 207)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P2.10-020 - Dose escalation and pharmacokinetic study of carboplatin and pemetrexed for elderly patients with advanced non-squamous, non-small-cell lung cancer: Kumamoto Thoracic Oncology Study Group Trial 1002 (ID 1329)

      09:30 - 09:30  |  Author(s): H. Kishi

      • Abstract

      Background
      This study was designed to determine the recommended dose of carboplatin-pemetrexed in elderly(≧70 years old), chemotherapy-naïve patients with advanced non-squamous non-small-cell lung cancer. Also, we measured the blood level of pemetrexed in order to explore significant factors associated with toxicity or efficacy.

      Methods
      The patients were treated with carboplatin and pemetrexed every three weeks from 4 to 8 cycles. The dose of the anticancer drug escalated according to protocol.

      Results
      Grade 3 infection was observed as DLT at a dose of carboplatin AUC 5 and pemetrexed 500 mg/m[2], and we determined this phase as a recommended dose. Overall response rate was 15.3%, and the disease control rate was 76.9% in all cases. The median duration of progression-free survival was 3.9 months. The AUC of pemetrexed was associated with hematotoxicity, but not the efficacy. We observed that renal dysfunction induced high blood concentration of pemetrexed.

      Conclusion
      The combination of carboplatin AUC5 and 500mg/m[2] of pemetrexed is promising for elderly chemo-naïve patients with advanced non-squamous NSCLC, but dose reduction of pemetrexed may be required for patients with renal dysfunction in further study.

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    P3.10 - Poster Session 3 - Chemotherapy (ID 210)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.10-011 - Which do patients prefer as a first-line therapy, EGFR-TKI or chemotherapy, if they have NSCLC harboring EGFR mutation? A Vignettes study (LOGIK0903). (ID 1106)

      09:30 - 09:30  |  Author(s): H. Kishi

      • Abstract

      Background
      Treatment decision-making is associated with potential decisional conflict of patients. Aim of this study was to determine the preferences of advanced NSCLC patients for EGFR-TKI or chemotherapy as first-line therapy if they were in the situation of having a lung cancer harboring EGFR mutation, and to investigate the variables considered important to that preference.

      Methods
      Three vignettes were designed to assess the patients’, the physicians’ or medical staff members’ preferences for treatment decision-making and the reasons classified into five category such as “evidence level”, “type of drug administration”, “therapeutic efficacy”, “adverse events”, and “influence to ordinary life” behind the decision. HADS, FACT-L and characteristics of participants including gender, age, and performance status (PS) are also investigated in this analysis.

      Results
      Total 377 individuals containing 100 patients, 100 physicians, and 177 medical staff members were analyzed in this study, and 322 participants (85.4%) preferred to EGFR-TKI than chemotherapy as a first-line therapy. Preference rate of EGFR-TKI in patients was statistically significantly lower than those in physicians and medical staffs, 73%, 88% and 91%, respectively. Among the reasons we investigated, “therapeutic efficacy” was the only marginal significant reason for preference in patients (odds ratio: 3.88, p=0.06). In addition to “therapeutic efficacy”, “type of drug administration” and “influence to ordinary life” was the significant reasons for their preference in physicians (odds ratio: 11.57, 22.57 and 20.5, respectively). In pre-planned analysis, we found the difference of value between the patients and the physicians in “influence to ordinary life”.

      Conclusion
      If the patients have an advanced lung cancer with EGFR mutation, they may prefer EGFR-TKI as a first-line therapy to chemotherapy as well as physicians and medical staff members. However the reasons of those preferences among them may be different. We should consider continuation of patients’ ordinary life when we discuss about treatment decision-making with patients.