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• 11946

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

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11948

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    P2.24-002 - Tolerability and barriers to delivery of adjuvant Cisplatin/Vinorelbine chemotherapy in non small cell lung cancer (ID 213)

    09:30 - 09:30  |  Author(s): A. Jebb
    • Abstract

    Background
    Adjuvant Cisplatin and Vinorelbine chemotherapy has been shown to improve overall survival for patients with resected non-small cell lung cancer. In the Auckland region, we administer 400mg/m2 of Cisplatin over 5 cycles in an attempt to reduce toxicity. The aim of this audit is to review the number of patients treated with this chemotherapy at our centre, assess the rates of toxicity, examine patient outcomes, and identify barriers to adjuvant chemotherapy administration.

    Methods
    Patients starting Cisplatin and Vinorelbine between 1 January 2008 and 31 December 2010 were identified by the Auckland Hospital oncology pharmacy department. Their clinical records were reviewed with respect to demographics, details of chemotherapy received, and toxicities encountered. Cancer outcomes were also analysed, including recurrence and mortality rates. Subsequently a review of our local thoracic multidisciplinary team meetings held over the same time period was undertaken to identify barriers to adjuvant chemotherapy access.

    Results
    A total of 29 patients received Cisplatin and Vinorelbine over the 3 years as adjuvant treatment for non-small cell lung cancer. 24 patients had stage 2 or early stage 3 cancer, four patients had stage 1B, and one patient had stage 4 cancer with an isolated brain metastasis which had been resected. 23 (79%) patients received all planned cycles of chemotherapy. Five patients did stop early due to toxicity and one because of travel plans. The average number of cycles given was 4.58 and the average dose of Cisplatin received was 349mg/m2. The average time from surgery to chemotherapy initiation was 87 days. There were no treatment related fatalities in our group. 25 (86.2%) patients had at least grade 3 toxicity requiring either dose reduction or deferral. The majority of side effects were haematological in origin. As of the 31/05/2013, 14 of 29 patients have had cancer recurrences (48.3%) and 14 patients have died (48.3%), the lung cancer specific mortality was 37.9%. One patient has been lost to follow-up. One, two, and three year survivals were 89.7%, 79.3%, and 56% respectively. Over the three years examined, 48 patients discussed at our thoracic multidisciplinary meeting had resection of a primary lung cancer between stages 1b (size >40mm) and 3a. 20 of these patients received adjuvant chemotherapy. Of the remaining 28 patients, four declined treatment, five were not medically fit enough for chemotherapy, and four developed cancer recurrence shortly after their operation. 15 (54%) patients were mistakenly not offered chemotherapy when it may have been of potential benefit.

    Conclusion
    This audit would suggest lower utilisation of adjuvant chemotherapy than predicted, and no improvement in toxicity rates by reducing the dose of Cisplatin used per cycle. A higher likelihood of completing all planned chemotherapy was found. It highlights the prolonged waiting times to access chemotherapy and identifies barriers that inhibit suitable patients from accessing this important treatment. Several areas for improvement are identified. Our main recommendation would be to present all patients and review their pathology at multidisciplinary meeting following surgery. Our data is limited by its retrospective nature and small study population.