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F. Goupil
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ORAL 34 - Quality/Survival/Prognosis in Localized Lung Cancer (ID 153)
- Event: WCLC 2015
- Type: Oral Session
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:B.C. Cho, R.L. Keith
- Coordinates: 9/09/2015, 16:45 - 18:15, 201+203
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ORAL34.01 - Compliance with Follow-Up Programs After Surgery for Non-Small Cell Lung Cancer in the Phase III IFCT-0302 Trial (ID 2148)
16:45 - 16:56 | Author(s): F. Goupil
- Abstract
- Presentation
Background:
In patients operated on for non-small cell lung cancer, several guidelines recommend a follow-up based on regular clinic visits and chest CT-scans. However, evidence to support these recommendations is poor, in the absence of randomized data. The IFCT-0302 trial is a randomized multicenter trial which compared 2 follow-up programs after complete resection for a clinical stage I, II, IIIA and T4 (pulmonary nodules in the same lobe) N0-2 NSCLC (TNM 6[th] edition). We present the results of compliance with the follow-up programs for the first 2 years after randomization.
Methods:
In the CXR arm, follow-up consisted of clinic visit and chest X-rays. In the CCT arm, patients underwent clinic visit, chest X-rays, thoraco-abdominal CT scan plus fiberoptic bronchoscopy (only mandatory for squamous cell and large cell carcinomas). In both arms, procedures were repeated every 6 months after randomization during the first 2 years, and yearly until 5 years, in the absence of recurrence or second primary cancer. Supplementary procedures were allowed in case of symptoms. Primary endpoint was overall survival.
Results:
Between January 2005 and November 2012, 1775 patients were randomized (CXR: 888; CCT: 887). Patient characteristics were well balanced between the two arms : males 76.3%, median age 62 years (range: 33-87), adenocarcinomas 56.7%, stage I-II 82.1%, lobectomy or bilobectomy 86,8%, pre- and/or post-operative radiotherapy 8.7%, and pre- and/or post-operative chemotherapy 45%. Surveillance was performed in 97% of patients at 6 months, in 94% at 12 months, in 90% at 18 months and in 84% at 24 months, and did not differ between the 2 arms. Intervals between randomization and visits were respected with no difference between arms (mean +/-SD in months from randomization: 5.93 +/- 0.84; 11.95 +/- 0.98; 18.05 +/- 0.99; 24.18 +/-1.30, respectively). In the 757 patients of the CXR arm, who had a follow-up visit at 6 months and no recurrence, 754 (99.6%) had a clinic visit and 730 (96.4%) a chest X-ray. In the 706 patients of the CCT arm who had a follow-up visit at 6 months and no recurrence, 702 (99.4%) had a clinic visit, 478 (67.7%) a chest X-ray, 678 (96%) a chest CT-scan, and 342 (48.4%) a bronchoscopy. Comparable compliance results were observed at 12, 18 and 24 months. In the CXR arm, supplementary thoracic CT-scans were done in 119 patients (15.7 %) at 6 months, in 96 (14.4 %) at 12 months, in 78 (13.2%) at 18 months and in 58 (11.4%) at 24 months. Other supplementary procedures were more frequent in the CCT arm than in the CXR arm, consisting mostly of brain imaging (at 6 months, in 93 (13.2%) and 39 (5.2%) patients, respectively, p<.001).
Conclusion:
Compliance with the follow-up programs was excellent in terms of timing. Chest X-ray was often omitted in the CCT arm. In the CXR arm, supplementary CT-scans that did not lead to a diagnosis of recurrence or second primary cancer were performed in 10 to 15% of patients. In the CCT arm, the most frequently performed supplementary procedure was brain imaging.
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P1.07 - Poster Session/ Small Cell Lung Cancer (ID 221)
- Event: WCLC 2015
- Type: Poster
- Track: Small Cell Lung Cancer
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.07-013 - Real-Life 2-Year Therapeutic Strategies in the Management of 525 Small-Cell Lung Cancers: The ESCAP Study Preliminary Results (ID 1657)
09:30 - 09:30 | Author(s): F. Goupil
- Abstract
Background:
In the last years, new drugs and strategies have emerged in the management of lung cancer (LC). The French College of General Hospital Respiratory Physicians therefore promoted a prospective multicenter epidemiological study: the ESCAP study. This study was aimed to describe the therapeutic strategies implemented during the first 2-year after diagnosis in patients with LC followed in French General Hospital chest departments. We report below descriptive results for small-cell lung cancer (SCLC).
Methods:
For each patient with a LC diagnosed in 2010, a standardized form was completed at diagnosis and following each change in treatment strategy up to at least 2 years after diagnosis.
Results:
53 centers participated in the ESCAP study, and included 3,943 LC patients. Of these, 525 patients had a SCLC. Characteristics of SCLC patients at diagnosis were: mean age +/- standard deviation (SD), 65.6 +/- 10.8 years; male, 77%; never-smokers, 4.8%. The mean follow-up in SCLC patients was 10.5 months (SD: 8.8) and median number of strategies was 2 (Interquartile range: 1-3). Main strategy characteristics are summarized in the following table.
As regards first strategy, cisplatin (46%) and carboplatin (42%) were the most frequent used drugs associated with etoposide. As regards second strategy, the most frequently used drugs were topotecan (22%), etoposide (21%), or carboplatin (20%). Few patients received targeted therapy (< 1% in strategies 1 and 2).First strategy (N=525) Second strategy (N=309) Third strategy (N=153) Duration (months): mean+/-SD 5.4 +/- 4.5 3.6 +/- 3.5 2.7 +/- 2.4 Curative surgery 2% 1% - Radiotherapy 10% 47% 20% Radiochemotherapy 15% - - Chemotherapy 75% 55% 61% Exclusive supportive care 8% 14% 27% Patients died during the strategy 195 (37%) 134 (43%) 90 (59%) Patients with a new strategy 309 (59%) 153 (50%) 54 (35%)
Conclusion:
The ESCAP study describes the 2-year management of SCLC on real-life settings in France. Its preliminary results showed that 3 or 4 strategies were not uncommon in the management of SCLC patients.
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P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.01-048 - Real-Life 2-Year Therapeutic Strategies in the Management of Metastatic Non-Small-Cell Lung Cancers: The ESCAP Study (ID 1515)
09:30 - 09:30 | Author(s): F. Goupil
- Abstract
Background:
In the last years, new drugs and strategies have emerged in the management of lung cancer (LC). The French College of General Hospital Respiratory Physicians therefore promoted a prospective multicenter epidemiological study: the ESCAP study. This study was aimed to describe the therapeutic strategies implemented during the first 2-year after diagnosis in patients with LC followed in French General Hospital chest departments. We report below descriptive results for metastatic non-small-cell lung cancer (mNSCLC).
Methods:
For each patient with a LC diagnosed in 2010, a standardized form was completed at diagnosis and following each change in treatment strategy up to at least 2 years after diagnosis.
Results:
53 centers participated in the ESCAP study and included 3,943 patients. Among them, 3,418 patients had a NSCLC. NSCLC was metastatic in 2,003 patients. In patients with mNSCLC, the first therapeutic strategy was chemotherapy alone (56%) followed by palliative chemotherapy plus incidental radiotherapy (35%); 4% of patients died without any implemented therapeutic strategy (see figure). 29% of patients with chemotherapy alone as first strategy died without undergoing any other strategy and 70% had a second strategy (72% chemotherapy alone). 35% of patients with radiochemotherapy died without undergoing any other strategy and 64% had a 2[nd] strategy (73% chemotherapy alone). Figure 1 The most frequent chemotherapy during the first strategy was platinum salts doublet with pemetrexed (39%), followed by platinum salts doublet with paclitaxel (15%). Chemotherapy during the second strategy was second line chemotherapy (67%) or maintenance therapy (25%). EGFR-TKi (34%) and docetaxel (26%) alone were the most frequently prescribed drugs for second line chemotherapy, and pemetrexed (44%) and EGFR-TKi (26%) alone for maintenance therapy.
Conclusion:
The ESCAP study describes the 2-year management of metastatic NSCLC on real-life settings in France. Its preliminary results are consistent with the guidelines of the French National Cancer Institute.
