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N.B. Leighl
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P1.05 - Poster Session with Presenters Present (ID 457)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.05-069 - Stage II NSCLC Treated with Non-Surgical Approaches: A Multi-Institution Report of Outcomes (ID 4552)
14:30 - 14:30 | Author(s): N.B. Leighl
- Abstract
Background:
Standard management of stage II non-small cell lung cancer (NSCLC) is surgery, often followed by adjuvant chemotherapy. However, some patients do not undergo surgery for various reasons. The optimal non-surgical management of stage II NSCLC is undefined, with a paucity of data to guide decision making in this setting. We examined outcomes of stage II NSCLC patients who were treated with curative, non-surgical approaches.
Methods:
We performed a multi-institution review of stage II NSCLC patients treated non-surgically with curative intent between January 2002 and December 2012, across three major Canadian academic cancer centres. Data on demographics, comorbidities, staging, treatment, and outcome were collected. The primary endpoint was overall survival (OS). Logistic regression and Cox proportional hazard models were used to assess for factors associated with choice of therapy and OS.
Results:
158 patients were included for analysis. Median age 74 years (range 50-91); 44% female; 94% current/former smokers; 67% performance status (PS) 0-1. Stage II groupings: T2b-T3 N0 in 55%; N1 in 45%. The commonest reasons for no surgery were inadequate pulmonary reserve (27%) and medical comorbidities (24%). All patients received radical radiotherapy (RT) (median 60 Gy [range 48-75]). 73% received RT alone; 24% and 3% of patients received concurrent and sequential chemoradiotherapy (CRT), respectively. Of those who received RT only, 39% received conventional (1.8-2 Gy/day), 51% received hypofractionated (2.5-4 Gy/day) and 10% received stereotactic body RT (≥7.5 Gy/day). In multivariate analyses, CRT was less likely in patients ≥70 years old (OR 0.28, 95% CI 0.11-0.70, p=0.006), as well as in those with higher (>5) Charlson comorbidity scores (OR 0.34, 95% CI 0.13-0.90, p=0.03) or low (<10x10[9]/L) white blood cell (WBC) counts (OR 0.26, 95% CI 0.09-0.73, p=0.01). At time of analysis, 74% have died. Median OS was 22.9 months (95% CI 17.1-26.6 months). Patients receiving CRT had significantly longer median OS than those receiving RT alone (39.1 vs 20.5 months, p=0.0019). RT fractionation schedule (p=0.16) and nodal status (p=0.14) did not influence survival. After adjusting for possible confounders, treatment with CRT was associated with improved survival (HR 0.38, 95% CI 0.21-0.69, p=0.001), while elevated WBC (HR 2.45, 95% CI 1.48-4.04, p=0.0005) and poor PS (ECOG 2-3) (HR 1.87, 95% CI 1.16-3.01, p=0.01) were poor prognostic factors.
Conclusion:
Non-surgical approaches to management of stage II NSCLC are varied. Treatment with CRT was associated with significantly longer survival compared to RT alone, and a randomized trial may be warranted in this population.
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P1.06 - Poster Session with Presenters Present (ID 458)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.06-039 - Retrospective Study of the Incidence and Outcomes from Lung Cancer That Developed Following a Solid Organ Transplant (ID 5136)
14:30 - 14:30 | Author(s): N.B. Leighl
- Abstract
Background:
Organ transplant recipients (OTR) have an increased risk of developing post-transplant malignancies with lung cancer being one of the most common. We investigated incidence and outcomes of lung cancer in OTR managed at the University Health Network.
Methods:
The study population, patient characteristics, treatments and outcomes were summarized from solid OTR databases, our cancer registry and patient charts from January 1, 1980 to December 31, 2015. Univariate Kaplan-Meyer curves estimated overall survival (OS) by histology, stage and chemotherapy.
Results:
Amongst 7994 OTR (heart [N=765], lung [n=1668], liver [n=238], kidney [n=3273]), 123 developed lung cancer (1.54%) of which (55) 44.7% occurred in lung OTR; 108 (1.35%) patients had sufficient data for subsequent analyses. Median age: 62 years (29 - 85); male: 66%; smoking status at time of transplant - former/current/never/unknown: 62%/10%/15%/8%. Histologies included non-small cell lung cancer (NSCLC): 81%; small cell lung cancer (SCLC): 10%; neuro-endocrine tumours: 9%. NSCLC: Adjuvant chemotherapy, after it became standard of care (SOC), was given to 16% of eligible NSCLC patients. At recurrence, 28% received chemotherapy while 28% received a TKI. In patients initially presenting with stage IV NSCLC, 18% received chemotherapy and 3% received a TKI. SCLC: For limited and extensive stage SCLC patients, 83% and 60% received SOC chemotherapy, respectively. All: Where chemotherapy dosing was known (n=23), 42% of patients received initial dose reductions. For early stage patients, 22% required dose reduction and 11% had chemotherapy discontinuation due to toxicity. For stage IV patients, 42% required dose reductions and 50% required discontinuations.Median OS by Subgroup
Patients by Histology, Stage at Diagnosis & Systemic Treatment n median OS (months) 95% C.I. NSCLC: Stage I/II Systemic Treatment No treatment 48 11 37 24.9 25.7 24.9 (17.3-36.6) (14-51.6) (16.2-72.9) NSCLC: Stage III Systemic Treatment No treatment 7 1 6 24.6 84.0 24.6 (4.5-NA) NA (4.5-NA) NSCLC: Stage IV Systemic Treatment No treatment 33 7 26 3.2 8.7 2.3 (2-4) (4.7-52.4) (1.5-3.5) SCLC: Limited Stage Systemic Treatment No treatment 6 5 1 9.6 14.3 2.0 (2-NA) (8.4-NA) NA SCLC: Extensive Stage Systemic Treatment No treatment 5 3 2 1.7 5.5 0.2 (0.2-NA) (1.7-NA) (0.2-NA)
Conclusion:
Survival was poor in our OTR population compared to historical norms in non-transplant patients. A minority of NSCLC patients received adjuvant or palliative chemotherapy, while most SCLC patients were treated. Both often had sub-standard dosing. Chemotherapy appeared better tolerated in early stage disease.
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P1.07 - Poster Session with Presenters Present (ID 459)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: SCLC/Neuroendocrine Tumors
- Presentations: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.07-016 - Trends, Practice Patterns and Underuse of Surgery in the Treatment of Early Stage Small Cell Lung Cancer (ID 4070)
14:30 - 14:30 | Author(s): N.B. Leighl
- Abstract
Background:
Current National Comprehensive Cancer Network guidelines recommend pathologic mediastinal staging and surgical resection for all patients with clinically node negative T1 and T2 small cell lung cancer (SCLC), but the extent to which surgery is used for early stage SCLC is unknown.Our obejctive was to assess trends and practice patterns in the use of surgery for SCLC.
Methods:
Clinical stage T1 or T2N0M0 SCLC cases were identified in the National Cancer Database (NCDB), 2004 – 2013. Demographics and clinical characteristics of patients undergoing resection were analyzed. Hierarchical logistic regression was used to identify individual and hospital-level predictors of receipt of surgical therapy. Trends in the rates of surgical resection for eligible patients were analyzed over the study period.
Results:
9,740 patients were identified with a diagnosis of clinical T1 or T2 N0M0 SCLC. Of these, 2,210 underwent surgery (22.7%), with 1,421 (64.3%) of these patients undergoing lobectomy, 739 (33.4%) sublobar resections and 50 (2.3%) pneumonectomies. After adjustment for clinical, demographic and facility characteristics, Medicaid patients were less likely to receive surgery (OR0.65 95% CI 0.48 – 0.89, p=0.006), as were those with T2 tumors (OR0.25 CI0.22 – 0.29, p<0.0001). Academic facilities were more likely to resect eligible patients (OR 1.90 CI1.45 – 2.49, p<0.0001). Between 2004 and 2013, rates of resection more than doubled from 9.1% to 21.7%. Overall, 68.7% of patients were not offered surgery despite having no identifiable contraindication. In patients not receiving surgery, only 7% underwent pathologic mediastinal staging.Figure 1
Conclusion:
Although rates of resection are increasing, surgery is rarely used nationally in the treatment of potentially eligible SCLC patients. About two thirds of potentially eligible patients fail to undergo potentially curative surgery. Further study is required to address the lack of concordance between guidelines and practice.
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P1.07-017 - Indications for Adjuvant Mediastinal Radiation in Surgically Resected Small Cell Lung Cancer (ID 4073)
14:30 - 14:30 | Author(s): N.B. Leighl
- Abstract
Background:
Adjuvant mediastinal radiation (AMR) is an adjunctive therapy for patients with surgically resected small cell lung cancer (SCLC). However, little data guides its use. We sought to examine whether there was a survival benefit associated with AMR for resected SCLC patients and to define sub-populations who should be selected for AMR.
Methods:
Patients undergoing resection (lobectomy, pneumonectomy and sublobar resection) for SCLC were identified in the National Cancer Database, 2004 – 2013. Kaplan-Meier survival curves and Cox proportional hazards were used to evaluate the impact of receipt of AMR on survival. Hazard ratios were adjusted for patient comorbidity and demographic information, as well as tumor stage, grade, histology, margin status and receipt of adjuvant chemotherapy.
Results:
3,113 patients were identified. Those receiving AMR were younger, more likely to have greater pathologic T- and N- stage, more likely to undergo sublobar resection and have a positive margin. Kaplan-Meier curves showed better median survival for patients with N1-3 disease who received AMR. After adjustment, Cox models showed lower risk of death for N1, N2/3 and sublobar resection with AMR (HR0.79 CI0.65 – 0.96, p=0.02; HR 0.60 CI0.48 – 0.75, p<0.0001). In the overall cohort, AMR was not associated with better survival in node-negative patients. AMR was, however, associated with improved survival for patients receiving sublobar resection (HR0.72 CI0.58 – 0.92, p=0.006).Figure 1
Conclusion:
AMR has significant benefit for node-positive patients after resection for SCLC, especially those with pN2 or pN3. Patients undergoing sublobar resection may benefit from AMR.
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P2.03b - Poster Session with Presenters Present (ID 465)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.03b-008 - The Impact of Brain Metastases and Their Treatment on Health Utility Scores in Molecular Subsets of Lung Cancer Patients (ID 4348)
14:30 - 14:30 | Author(s): N.B. Leighl
- Abstract
Background:
New therapies, particularly in advanced patients with EGFR-mutated and ALK-rearranged tumors, result in prolonged survival. Brain metastases and/or their treatment, may have a negative impact on health-related quality of life. Technological assessment of the cost-effectiveness of various treatments for brain metastases will benefit from measurements of health-related qualify of life and health utility scores (HUS). This study evaluated the impact of brain metastases on HUS across multiple health states defined on the basis on disease stability, brain-specific therapies, and molecularly-defined subsets of NSCLC.
Methods:
A longitudinal cohort study at Princess Margaret Cancer Centre evaluated 1571 EQ5D-3L-derived HUS in 476 Stage IV lung cancer outpatients, from Dec, 2014 through May, 2016: EGFR+ (n=183), ALK+ (n=38), wild-type (WT) non-squamous (n=171), squamous (n=29), and small cell lung cancer (SCLC) (n=30). Patients were stratified according to presence or absence of brain metastases at the time of assessment; mean HUS (± standard error of the mean, SEM) by presence of brain metastases and various health states and disease subtypes were reported. For patients with repeated measures, only the earliest time point was analyzed.
Results:
172 patients had brain metastases, median age 62, (range 32-86) years and 304 patients did not have brain metastases, median age 66 (29-96) years. Overall HUS was related to disease subtype but not presence of brain metastases: EGFR/ALK+ patients with (0.78±0.02) or without brain metastases (0.79±0.01) versus WT/SCC/SCLC with (0.74±0.02) and without brain metastases (0.73±0.01) (p=0.01 by subtype; p>0.10 by presence of brain metastases). However, symptomatic CNS disease (0.69±0.04) had lower HUS (versus asymptomatic disease (0.77±0.02)) (p=0.03). Patients achieving intracranial stability or response to treatment had significantly higher HUS (0.81±0.05) than patients with progressive CNS metastases (0.72±0.02) (p=0.03). Extra-cranial control also correlated with higher HUS (0.81±0.02 versus 0.69±0.03, p<0.0001). When local treatment for brain metastases was delivered within 6 months, HUS was lower (0.71±0.02 versus 0.82±0.02, p=0.0005). CNS disease treated only with systemic therapy or on no active therapy had mean HUS of 0.81±0.03, while patients treated only with stereotactic radiosurgery (SRS) had values of 0.80±0.04; there was a trend for lower HUS with whole brain radiation (WBRT) only (0.72±0.03) or WBRT+SRS (0.74±0.03) (p=0.11).
Conclusion:
Brain metastasis stability has significant impact on HUS in lung cancer patients. Treatment modalities of brain metastases may also impact HUS. Data collection is ongoing; updated HUS data including longitudinal assessments and multivariable analyses will be presented.
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P2.08 - Poster Session with Presenters Present (ID 491)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Patient Support and Advocacy Groups
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.08-001 - Giving a Voice to Patients and Caregivers through the Lung Cancer Canada ‘Faces of Lung Cancer’ Survey (ID 4340)
14:30 - 14:30 | Author(s): N.B. Leighl
- Abstract
Background:
Lung cancer (LC) is a major cause of cancer death, morbidity and loss of function. Caregivers of LC patients provide emotional, physical, and financial support, but their contribution is under-reported. The Lung Cancer Canada (LCC) Faces of Lung Cancer Survey aimed to study the impact of LC diagnosis and treatment on patients and caregivers.
Methods:
This 15-minute online survey for patients and caregivers was conducted in August 2015. Participants were recruited from a database of patients and caregivers, who previously consented to survey participation; targeted emails, social media postings and other patient groups were also utilized. The questionnaire covered demographics, emotional issues and stigma, symptom burden, quality of life, treatment experiences, and unmet needs. Anonymously collected results were collated by LCC.
Results:
Overall, 91 patients and 72 caregivers completed 163 interviews. Of surveyed patients, 57% had no active cancer. Fatigue, depression, and respiratory complaints were the most challenging symptoms for patients. Fear/uncertainty was reported as the hardest thing about LC by 40% of patients and 17% of caregivers. Most caregivers were partners (54%) or parents (38%). 60% were the primary caregiver, and 79% were former caregivers: 68% of their care receivers had died. Most caregivers coped well (79%), but stressors included care-receiver’s declining health, their own emotions, and balancing responsibilities. Caregivers reported more negative feelings than patients: anxious/stressed 61%v42%, depressed/hopeless 32%v11%, cared for 13%v38%, confident/encouraged 11%v25%. Caregivers felt less support than patients from their healthcare team (75%v92%) and family/friends (65%v87%). Treatment satisfaction was lower among caregivers: only 58% felt very/somewhat satisfied (v 82% patients). 60% of patients and 68% of caregivers reported a negative stigma attached to LC. 35% of respondents felt there was less empathy toward LC than other cancers, and 38% of caregivers felt they had to advocate harder for LC than other cancers. Notably, some caregivers (8%) and patients (5%) reported a lack of compassion from medical professionals after a LC diagnosis. 37% of patients and 50% of caregivers reported a negative household financial impact from LC diagnosis.
Conclusion:
This report on the experiences of lung cancer patients and their caregivers highlights their reactions to the illness, and the associated prejudice and stigma. Lung Cancer Canada is working to improve patient access to supportive services, to decrease caregiver burden through support initiatives such as peer-to-peer support programs, to educate patients and caregivers on LC and their treatment options, and to advocate for LC patients in the face of established stigma.
