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S. Ekman
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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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P1.06-041 - Overall Survival and Intermediate Outcomes among Scandinavian Non-Small Cell Lung Cancer Patients: The SCAN-LEAF Study (ID 5141)
14:30 - 14:30 | Author(s): S. Ekman
- Abstract
Background:
The past decade has seen several advances in the field of non-small cell lung cancer (NSCLC), with improved tools for tumor characterization as well as novel targeted and immune therapies. It is important to understand the current treatment landscape including treatment outcomes, in order to maximize patient benefits from these advances. SCAN-LEAF is a Scandinavian retrospective cohort study with prospective annual data cuts, providing a unique opportunity for insights into real-world clinical NSCLC practice over more than a decade. It includes clinical practice patterns of tissue biopsy, pathological diagnosis and tumor biomarker status testing, and their relationship to treatment choices and outcomes. Here, we present intermediate and survival outcomes by disease stage and histology subtype, and factors associated with survival.
Methods:
SCAN-LEAF consists of a registry-based cohort including all diagnosed NSCLC patients in Denmark, Norway and Sweden (Cohort 1), and a Swedish sub-cohort (Cohort 2) supplemented with data from electronic medical records (EMRs). Based on the first data collection including data from NSCLC patients diagnosed 2005-2013, overall survival (OS; Cohort 1 & 2) and progression-free survival (PFS; Cohort 2) will be estimated using Kaplan-Meier analysis and reported as cumulative incidences (with 95% CI) by disease stage at diagnosis, histological subtype, biomarker status, presence of metastases, age and gender. Response rates (Cohort 2) will be described by treatment line in addition to stage and histology subtype. Association of stage with survival (Cohort 1 & 2) and treatment response (Cohort 2) will be analyzed by Cox regression with time to event (death or response) as outcome variable and disease stage category at diagnosis, follow-up time, and therapy line as stratification variables. In addition, the relationship between OS and intermediate outcomes, as well as predictors of OS (e.g. smoking and biomarker status, lesion location, metastasis at diagnosis), will be explored by Cox regression (Cohort 2).
Results:
Intermediate and survival outcomes for Scandinavian NSCLC patients diagnosed between 2005 and 2013, as well as any association between overall survival and factors such as patient characteristics and treatment patterns, will be presented.
Conclusion:
The SCAN-LEAF study, expected to include >115,000 Scandinavian NSCLC patients and >2,000 sub-cohort patients diagnosed between 2005 and 2018 during the full duration of the study, will give valuable insights into current care, changing treatment patterns and patient outcomes in a real-world setting. A better understanding of factors associated with survival and intermediate outcomes among NSCLC patients will inform clinical decision-making.
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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-013 - Outcome of Patients with ALK+ NSCLC and Brain Metastases in Relation to Disease Burden and Clinical Management (ID 5086)
14:30 - 14:30 | Author(s): S. Ekman
- Abstract
Background:
The management of ALK+ NSCLC patients with CNS metastases represents a clinical challenge. We conducted this single institution retrospective analysis in order to evaluate the frequency of CNS metastases in this patient group and explore clinical features associated with survival
Methods:
Between 2011 and 2016, 70 patients with advanced ALK+ adenocarcinoma were treated at our institution. Data on CNS imaging modality, treatment strategy and outcome was collected by chart review
Results:
CNS imaging was performed with either MRI(36%) or CECT(64%) in 59 cases, and CNS metastases were diagnosed in 56% of examined subjects. The characteristics of these 33 patients were as follows: gender male/female 45%/54%; median age 60y (IQR 50-65); # of CNS metastases 1-3/4-10/>10 21%/36%/42% (including 3 subjects with leptomeningeal involvement); timing for diagnosis of CNS metastases: at primary cancer diagnosis (21%), at PD on chemotherapy (33%), at PD on crizotinib (39%), at PD on 2[nd] generation ALKi (6%). Radiotherapy was administered as either SRS(42%) or WBRT(58%) in 66% of cases. Overall medical treatment was chemotherapy (n=32); crizotinib (n=28); 2[nd] generation ALKi, either alectinib, ceritinib or brigatinib (n=22). The first treatment strategy upon diagnosis of CNS metastases was radiotherapy alone, crizotinib or a 2[nd] gen ALKi in 42%, 24% and 33% of subjects, respectively. In 4 cases, the 2[nd] generation ALKi was started directly after completion of radiotherapy. Median OS from the diagnosis of CNS metastasis was 18 months (95% CI 9-50). 1- and 2-year survival rates were 59% and 44%, respectively. Cox proportional hazard analysis showed that neither gender, age, timing for diagnosis of CNS metastasis nor the use of radiotherapy were significant prognostic factors for OS in this patient cohort. Survival analysis stratified by Number of CNS metastasis showed a trend favoring 1-3 met (median OS 59 months) vs 4-10 and >10 lesions (median OS of 25 and 9 months, respectively), with the three survival curves crossing each other (p=0.1). On the other hand, the first treatment strategy after the diagnosis of CNS metastases was shown to be indeed a significant prognostic factor for OS. Median OS for patients treated with crizotinib, radiotherapy alone or a 2[nd] ALKi (with or without RT) was 9 months, 29 months and Not reached, respectively (p=0.03).
Conclusion:
This retrospective study confirms the high incidence of CNS metastases in Caucasian patients with advanced ALK+ NSCLC. The wider implementation of 2[nd] generation ALKi in clinical practice may change the prognosis of these subjects
