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M. Behera
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ORAL 20 - Chemoradiotherapy (ID 124)
- Event: WCLC 2015
- Type: Oral Session
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:G. Blumenschein, J.Y. Chang
- Coordinates: 9/08/2015, 10:45 - 12:15, 201+203
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ORAL20.01 - A Systematic Review of Carboplatin-Paclitaxel versus Cisplatin-Etoposide Concurrent with Thoracic Radiation for Stage III NSCLC Patients (ID 600)
10:45 - 10:56 | Author(s): M. Behera
- Abstract
- Presentation
Background:
The two most commonly used chemotherapy regimens deployed concurrently with thoracic radiation (RT) for patients with unresectable IIIA and IIIB non-small cell lung cancer (NSCLC) are carboplatin/paclitaxel (CP) and cisplatin/etoposide (CE). Because there are no prospective comparisons of these two regimens in this setting, we conducted a systematic review of published trials to compare outcomes and toxicities between CE and CP.
Methods:
Studies which enrolled stage III patients receiving RT with CP or CE were identified using electronic databases (MEDLINE, EMBASE, and Cochrane library) and meeting abstracts. Trials were excluded if they were phase I, enrolled less than 10 pts, or included surgical resection. A systematic analysis of extracted data was performed using Comprehensive Meta Analysis (Version 2.2) software using random and fixed effect models. Clinical outcomes were compared using point estimates for weighted values of median overall survival (OS), progression free survival (PFS), response rate (RR) and toxicities. Two-tailed T-test with a significance level of 0.05 was used for all comparisons.
Results:
3194 patients were included from 32 studies in the CE arm, and 3789 patients from 51 studies in CP. Baseline characteristics of patients on the CE arm versus CP arm were: median age 61 vs. 63 years, male 67.6% vs. 78%, squamous histology 39% vs. 40%, and median radiation dose 62 Gy vs. 63 Gy. There was no significant difference in response rates between CE and CP (65% vs. 56%, p =0.6), respectively. There was no significant difference in median progression free survival (11.5m vs. 9.3m p =0.2), overall survival (19.8m vs. 18.4m, p=0.48), 1-year survival rate (66% vs. 65%, p=0.8), or 3-year survival rate (31% vs. 25%, p=0.4) for CE vs. CP. CE was associated with higher grade 3/4 hematological toxicities than CP, such as neutropenia (53% vs. 23% p<0.0001), thrombocytopenia (14% vs. 6% p=0.001), anemia (16% vs. 8% p=0.06), as well as grade 3/4 nausea/vomiting (20% vs. 9% p=0.018), while rates of grade 3/4 pneumonitis and esophagitis were similar.
Conclusion:
CE and CP regimens were associated with comparable efficacy when used with concurrent radiotherapy for stage III unresectable NSCLC pts. The toxicity profile favored the CP regimen.
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P1.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 224)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.08-020 - Survival Impact of Adjuvant Radiation and Chemotherapy in Patients with Typical and Atypical Pulmonary Carcinoids (ID 3054)
09:30 - 09:30 | Author(s): M. Behera
- Abstract
Background:
Adjuvant chemotherapy or radiation is commonly employed after resection of primary pulmonary carcinoid especially for patients with advanced stage disease with expectation of survival benefit. The indication for adjuvant therapy is poorly defined and there are limited data in support of this clinical practice. We therefore evaluated predictors and potential benefit of adjuvant chemotherapy and radiation using the National Cancer Database (NCDB), an oncology outcomes database administered by the American College of Surgeons and the American Cancer Society
Methods:
The NCDB was queried for patients who had undergone surgical resection of pulmonary carcinoid tumors between 2003 and 2006. Patients younger than 18 years and those with incomplete survival data were excluded from this analysis. Overall survival was defined as time from date of definitive surgery to date of death or last follow-up. Univariate and multivariable models were employed to assess for association between patient survival and variables of interest. Gender, age, and race were fit in a multivariable Cox model with treatment, and backward selection criteria (alpha = 0.1) were used to determine whether education, urban/rural, tumor size, income, laterality, insurance, or comorbidity score were included in the model. The proportional hazards assumption was checked for all models.
Results:
We included 4984 eligible patients diagnosed between 2003 and 2006 in the analysis. Post resection adjuvant radiation was administered to 4.2% of the patients; 1.9% received chemotherapy while the remaining patients did not receive any adjuvant therapy. Patients treated with adjuvant chemotherapy or radiation had worse survival at 2 years post surgery (75.7% and 70.8%% respectively) in comparison to patients managed with surgical resection only (94.2%). This survival difference was still significant in multivariable Cox models after adjusting for relevant patient and prognostic factors including gender, age, race, stage, lymph node involvement, tumor size, education level and co-morbidity score (HR: 2.35, 95% CI: 1.43 - 3.85, p<0.001 and HR: 1.97, 95% CI:1.48 - 2.61, p<0.001 for adjuvant chemotherapy and radiation, respectively). Decreased survival persisted in analyses restricted to patients with lymph node involvement (HR 1.58, p 0.084 and 3.21, p<0.001 for chemotherapy and radiation, respectively), and with advanced stage cancer (HR 4.10, p <0.001 and 2.04, p=0.036 and for radiation and chemotherapy, respectively) . Results did not differ by histology
Conclusion:
We observed worse outcomes in patients with typical and atypical carcinoid treated with adjuvant chemotherapy and radiation post surgery. The poor outcome associated with adjuvant therapy may be explained in part by the fact that patients considered for adjuvant therapy are more likely to have advanced stage disease and adverse tumor characteristics. However, contribution from potential toxicities of chemotherapy and radiation cannot be entirely excluded pending additional analysis in propensity-matched cohorts of 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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P2.01-068 - Androgen Deprivation Therapy for Prostate Cancer Associated with Improved Survival in Non Small Cell Lung Cancer: A SEER-MEDICARE Analysis (ID 2743)
09:30 - 09:30 | Author(s): M. Behera
- Abstract
Background:
Cancer of the prostate and lung are most commonly diagnosed in the elderly. Aberrant female sex hormone signaling has been well-described in NSCLC. The impact of androgen deprivation therapy (ADT) on non-small cell lung cancer (NSCLC) outcome has, however, not been well studied.
Methods:
We employed the linked SEER-MEDICARE database to assess the potential impact of ADT on NSCLC. We analyzed data from patients diagnosed with NSCLC between 1985 and 2005 and registered in the SEER-MEDICARE database. Patients were categorized into three groups: prostate cancer diagnosis followed by NSCLC (PL), NSCLC followed by prostate cancer (LP) and NSCLC only (L). Demographic and survival outcomes were compared between these groups. The impact of sequence of cancer diagnosis and ADT on survival post NSCLC diagnosis was assessed within the PL group using logistic regression model. Cox proportional hazards models were employed to estimate the effect of ADT and stage of prostate cancer on survival with adjustment for significant prognostic factors.
Results:
A total of 417630 patients were included in this analysis; male/female (56.4%/43.6%); Race: White (84.0%), Black (9.0%), Asian (2.1%), Hispanic (1.0%), others (3.0%); Stage: I (17.4%), II (2.9%), III (33.6%) and IV (46.1%). The majority of the patients were in the L group (96.3%), followed by PL (2.9%) and LP (0.8%). Patients in the LP group had the best 12-month survival rates (84.5%), followed by L (44.4%) and PL (40.1%). Analysis within the PL group showed an inverse correlation between stage of prostate cancer diagnosis and interval of time to NSCLC diagnosis: 54.8, 54.1, 62.1 and 59.3 months for stage I, II, III and IV prostate cancer, respectively. Prostate cancer patients exposed to ADT had a shorter interval to lung cancer diagnosis (48.3 vs. 52.7 months; p < 0.001). On multivariate analysis, patients exposed to ADT had a higher median survival (10 months vs. 9 months; p < 0.001) and reduced risk of death (HR:1.11; 95%CI:1.05-1.18), p <0.001).
Conclusion:
ADT therapy for prostate cancer was associated with improved survival for subsequent NSCLC diagnosis. Our result supports systematic exploration of ADT as a treatment strategy for NSCLC.
