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W.Y. Koh
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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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P2.01-019 - Effect of EGFR Mutation Status on Graded Prognostic Assessment for Non-Small Cell Lung Cancer and Brain Metastases (ID 1055)
09:30 - 09:30 | Author(s): W.Y. Koh
- Abstract
Background:
The aim of this study is to refine the existing lung cancer graded prognostic assessment (GPA) index by analysing a cohort of patients with non-small cell lung cancer (NSCLC) tested for epidermal growth factor receptor (EGFR) mutation status and newly diagnosed brain metastases.
Methods:
We used the pathology registries of two institutions to identify 259 eligible patients diagnosed with brain metastases secondary to NSCLC between 2006 and 2014. We linked the electronic medical records of these patients to the National Death Registry. Survival is defined as from date of first treatment for brain metastases or date of brain metastases diagnosis for patients on best supportive care till death. We analysed the prognostic factors significant for survival by multivariate Cox regression and recursive partitioning analysis (RPA).
Results:
Significant prognostic factors identified by multivariate Cox regression and RPA were age, Karnofsky performance status (KPS), presence of extra-cranial metastases (ECM), number of brain metastases (BM) and presence of sensitizing EGFR mutations. Patients who were age 70 years old and above (Hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.07-2.01, reference (ref) age < 70 years old); with KPS score 70-80 (HR 2.37, 95%CI 1.69-3.34, ref KPS 90-100); with KPS score < 70 (HR 4.34, 95%CI 2.90-6.51, ref KPS 90-100); ECM present (HR 1.82, 95%CI 1.27-2.62, ref no ECM); having two or more BM (HR 1.40, 95%CI 1.01-1.95, ref less than two BM) and absence of sensitizing EGFR mutations (HR 1.97, 95%CI 1.49-2.61, ref sensitizing EGFR mutations present) were poor prognostic factors. There was a robust separation of survival curves between GPA score 0-1.0 (median survival (MS) 2.1 months), GPA score 1.5-2.0 (MS 6.3 months) and GPA score 2.5-3.0 (MS 14.1 months). The proposed modified GPA index is shown in below table.Proposed modified GPA index
Prognostic factors / score 0 0.5 1.0 Age Group ≥70 years old <70 years old - KPS <70 70-80 90-100 ECM Present - Absent No. of BM ≥2 0-1 Sensitising EGFR mutations Absent - Present
Conclusion:
EGFR mutation status is a significant prognostic factor and should be considered in the design of lung-cancer GPA index. The proposed modified GPA index need to be validated with an independent dataset.
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P2.07 - Poster Session/ Small Cell Lung Cancer (ID 222)
- Event: WCLC 2015
- Type: Poster
- Track: Small Cell Lung Cancer
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.07-007 - Prophylactic Cranial Irradiation for Extensive Stage Small Cell Lung Cancer (ID 52)
09:30 - 09:30 | Author(s): W.Y. Koh
- Abstract
Background:
The survival benefit of prophylactic cranial irradiation (PCI) in extensive stage small-cell lung cancer (ES-SCLC) reported by an EORTC randomized trial in 2007 has been questioned recently, as a Japanese study with similar trial design failed to show similar results. This retrospective cohort study aims to evaluate the uptake of PCI and its impact on the survival of ES-SCLC before and after publication of the EORTC randomized trial.
Methods:
All patients diagnosed with ES-SCLC without brain metastases and had stable disease or better after first line chemotherapy in the only two Singapore national cancer centers from 2003 to 2010 were identified using the institutions’ pathology registries. We linked the treatment records to the national death registry. We described the utilization of PCI and compared survival of patients diagnosed from 2003 to 2006 (pre-adoption cohort) with patients diagnosed from 2007 to 2010 (post-adoption cohort). Characteristics between pre and post-adoption cohorts were analyzed using chi-square test. Survival was determined from date of diagnosis to death using Kaplan-Meier method. Predictors for improved survival were determined using multivariate analysis.
Results:
71 patients were identified. The demographic and clinical characteristics were similar between the two cohorts save for more patients in the post-adoption cohort having second line therapy (49% versus (vs) 16%, P = 0.01) and receiving PCI (32% vs 10%, P = 0.04). There was no difference in overall survival between the two cohorts (Hazard ratio [HR] 0.70; 95% Confidence Interval [CI] 0.43 to 1.13, P = 0.148). Multivariate analysis showed that PCI (HR 0.47; 95% CI 0.24 to 0.91, P = 0.024) and thoracic radiotherapy (HR 0.49; 95% CI 0.28 to 0.86, P = 0.013) was associated with lower risk of death.
Conclusion:
There was an increase in the uptake of PCI for ES-SCLC since 2007. The use of PCI and thoracic radiotherapy has been shown to be predictors for improved survival in ES-SCLC who had stable disease or better after first line chemotherapy. A larger population based outcome study is warranted to confirm these observations.
