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R.M. Bremnes
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P3.07 - Poster Session/ Small Cell Lung Cancer (ID 223)
- Event: WCLC 2015
- Type: Poster
- Track: Small Cell Lung Cancer
- Presentations: 2
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.07-014 - Associations between Comorbidity, Treatment Toxicity and Overall Survival in Limited Disease Small-Cell Lung Cancer (LD-SCLC) (ID 2739)
09:30 - 09:30 | Author(s): R.M. Bremnes
- Abstract
Background:
Concurrent chemotherapy and thoracic radiotherapy (TRT) is the recommended treatment of LD-SCLC. The treatment often causes severe toxicity. Many patients have comorbidity due to old age and smoking, and it is unclear whether these patients tolerate and benefit from the treatment as much as more fit patients. Studies have shown that comorbidity is a negative prognostic factor in many cancers (including lung cancer), but this has not been investigated in LD-SCLC patients receiving chemo-radiotherapy. We investigated whether comorbidity was a prognostic factor or associated with severe toxicity in a randomized trial comparing two schedules of TRT in LD-SCLC (n=157).
Methods:
Patients received four courses of cisplatin plus etoposide and were randomized to receive concurrent TRT of either 45 Gy/30 fractions (twice daily) or 42 Gy/15 fractions (once daily). Responders were offered prophylactic cranial irradiation of 30 Gy/15 fractions. The Charlson Comorbidity Index (CCI) was used to assess comorbidity from hospital medical records. The CCI rates common conditions associated with increased 1-year mortality with scores of 1, 2, 3 or 6 based on severity - and a total score (“CCI-score”) is calculated. Toxicity was assessed using the CTCAE v3.0. We adjusted for treatment arm and established baseline prognostic factors in lung cancer (gender, stage of disease, appetite loss, weight-loss, age and performance status (PS) in the multivariate analyses.
Results:
157 patients were analyzed (100%). Median age was 63 years, 52% were men, 16% had PS 2, 72% stage III, 30% weight-loss >5% last 3 months and 46% received twice-daily TRT. The most common grade 3-4 toxicities were pneumonitis (n=4; 3%); esophagitis (n=50; 32%) and neutropenic infections (n=64; 41%). 4 patients (3%) died from pneumonitis. 63 patients (40%) had CCI-score 0; 54 (34%) CCI-score 1; 23 (15%) CCI-score 2; 13 (8%) CCI-score 3; 3 (2%) CCI-score 4 and 1 patient had CCI-score 5 (1%). Most common comorbidities were chronic obstructive pulmonary disease (n=60, 38%), peptic ulcer disease (n=19, 12%), previous myocardial infarction (n=17, 11%) and diabetes (n=17, 11%). Median overall survival (OS) for the whole population was 22.7 months. There were no significant associations between CCI-score and median OS in univariate (CCI-score 0: 30.6 months; CCI-score 1: 15.1 months; CCI-score 2: 23.0 months; CCI-score 3: 23.0 months and CCI-score 4-5: 9.3 months, p=0.18) or multivariate analyses (HR: 0.97; 95% CI 0.79 – 1.18, p=0.74). Patients with comorbidity had a shorter survival than others in the univariate (CCI-score 0: 30.6 months, CCI-score ≥1: 18.8 months, p=0.047), but not in the multivariate analysis (HR: 1.27; 95% CI 0.82–1.98, p=0.29). Patients with comorbidity did not experience significantly more grade 3-4 pneumonitis (CCI-score 0: 3%, CCI-score ≥1: 2%, p=1.0), esophagitis (CCI-score 0: 38%, CCI-score ≥1: 28%, p=0.17), neutropenic infections (CCI-score 0: 41%, CCI-score ≥1: 40%, p=0.92) or deaths from pneumonitis (CCI-score 0: 2%, CCI-score ≥1: 3%, p=0.65). There were no other significant associations between CCI-scores and overall survival or toxicity.
Conclusion:
LD-SCLC patients with comorbidity had similar survival and toxicity as others, suggesting that they should be offered similar treatment as those without comorbidity.
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P3.07-016 - Survival of Patients with N3 Lymph Node Disease in a Cohort with Limited Disease Small-Cell Lung Cancer Receiving Concurrent Chemoradiotherapy (ID 1134)
09:30 - 09:30 | Author(s): R.M. Bremnes
- Abstract
Background:
Treatment of small-cell lung cancer depends on the extent of disease. Concurrent chemotherapy and thoracic radiotherapy (TRT) is recommended if all lesions can be included in a radiotherapy field (limited disease – “LD”), while patients with more advanced disease (extensive disease – “ED”) receive chemotherapy alone. LD is defined as confined to one hemithorax, but some have excluded patients with contralateral hilar and supraclavicular lymph node metastases (LNM). When the latest revision of TNM was published, it was recommended that N3-disease should be considered as LD with the possible exception of supraclavicular LNM – and that TNM-stage should be reported in clinical trials of LD SCLC to further explore this. We assessed extent of disease according to TNM v7 in patients from a randomized phase II trial comparing two schedules of TRT in LD SCLC (n=157) and investigated whether N3-disease was a negative prognostic factor; and whether there were survival-differences between the different N3-subcategories.
Methods:
Patients received four courses of cisplatin plus etoposide and were randomized to receive concurrent thoracic radiotherapy of either 45 Gy/30 fractions (twice-daily) or 42 Gy/15 fractions (once daily). Responders were offered prophylactic cranial irradiation of 30 Gy/15 fractions. Extent of disease was assessed from CT scans obtained three weeks before chemotherapy commenced. N3-disease was categorized according to contralateral supraclavicular, ipsilateral supraclavicular, contralateral hilar and contralateral mediastinal LNM. Weight loss was defined as weight loss >5% the last 3 months prior to enrolment.
Results:
150/157 patients were analysed (96%). Median age was 63 (40-85); 51% were men; 15% had PS 2 and 46% received twice-daily TRT. 1% had stage I disease; 14% stage II; and 84% stage III. Median overall survival (OS) for stage I: not reached, stage II: 41.1 months, and stage III: 20.9 months (p=0.022). 17% had N0-disease; 5% N1-disease; 30% N2-disease; and 47% had N3-disease. Among those with N3-involvement, 40 % had contralateral mediastinal LNM, 16% contralateral hilar LNM, and 17% supraclavicular LNM (13% ipsilateral and 7% contralateral supraclavicular LNM). 43% had LNM to more than one N3-station. Patients with N3-disease had inferior survival compared with N0-2 disease (18.0 vs. 33.7 months; p<0.001). All subcategories of N3 had inferior median OS compared with N0-2 disease (median 33.7 months): contralateral mediastinal LNM (18.0 months; p=0.022), contralateral hilar (19.8 months; p=0.021), supraclavicular LNM (15.1; p=0.003) [ipsilateral supraclavicular LNM (15.1 months; p=0.009) and contralateral supraclavicular LNM (13.8 months; p=0.007)]. There were no significant differences in median OS between the different N3-categories (p=0.84). Multivariate analyses adjusting for established prognostic factors in lung cancer (gender, age, PS, weight-loss and appetite loss) and treatment showed that N3-disease (HR 2.30; 95% CI=1.51-3.48; p<0.001), supraclavicular LNM (HR 1.67; 95% CI=1.01-2.77; p=0.046) and contralateral mediastinal LNM (HR 2.34; 95 % CI = 1.55-3.51; p<0.001) remained significant prognostic factors.
Conclusion:
Patients with N3-disease had inferior OS to those with N0-2 disease. All subcategories of N3 had inferior OS in the univariate analyses, while supraclavicular and contralateral mediastinal LNM remained significant in the multivariate analyses. Patients with supraclavicular LNM had similar OS as other N3 subcategories.
