Author of

• 17556

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  P2.03a - Poster Session with Presenters Present (ID 464)

  • 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)

  • 17564

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    P2.03a-008 - Relative Dose Intensity of First-Line Chemotherapy and Overall Survival in Patients With Advanced Non–Small-Cell Lung Cancer (NSCLC) (ID 4736)

    14:30 - 14:30  |  Author(s): P.K. Morrow
    • Abstract

    Background:
    For patients with advanced NSCLC, chemotherapy dose reductions/delays are commonly used to manage toxicities. However, there is limited information on the relationship between relative dose intensity (RDI) and survival in metastatic NSCLC. Objective: Describe the relationship between RDI and survival in patients with NSCLC in a US community oncology practice setting.
    
    Methods:
    This was a retrospective study using the McKesson Specialty Health/US Oncology iKnowMed[SM] electronic health record database. Inclusion criteria: Patients with advanced (stage III/IV) NSCLC who initiated first-line, intravenous, myelosuppressive chemotherapy between January 2007 and December 2010. Endpoints: Mean RDI (a composite measure including both dose delays and dose reductions), RDI <85%, and incidences of dose delays ≥7 days and dose reductions ≥15% in any chemotherapy cycle. Dosing analysis covered a period up to 6 months after chemotherapy initiation. Univariable and multivariable analyses for survival were conducted using Cox proportional hazard regression.
    
    Results:
    Overall, 3866 patients with NSCLC were included; the most common chemotherapy regimens included carboplatin/taxol (n=1733), pemetrexed/carboplatin (n=789), and bevacizumab/carboplatin/taxol (n=734). 709 (18.3%) received colony-stimulating factor primary prophylaxis. The mean (SD) RDI was 83.9% (28.5%), the incidence of RDI <85% was 40.4%, and the incidence of dose delays ≥7 days and dose reductions ≥15% were 32.4% and 50.1%, respectively. Univariable analysis suggested that dose delay ≥7 days was associated with a 22.4% reduction in the risk of death (P<0.0001). Multivariable analysis suggested that RDI and dose delay were significant predictors of survival after controlling for covariates. RDI <85% and dose delay ≥7 days were associated with a 17.6% increase and a 29.0% reduction in risk of death, respectively (Table).
    
    Conclusion:
    Reduced RDI and chemotherapy dose delays were common in advanced NSCLC and significantly associated with survival in a multivariable analysis. Understanding the complex effect of dose intensity on outcomes will be important for managing toxicities and improving survival.

    Table. Multivariable Cox Regression Analysis for Overall Survival for Patients with Lung Cancer
    Variable		HR (95%CI)		P Value
    RDI <85% (reference: ≥85%)		1.176 (1.047–1.320)		0.0062
    Dose delay ≥7 days (reference: <7 days)		0.710 (0.630–0.800)		<0.0001
    ECOG performance status (reference: status of 0)
    1		1.316 (1.192–1.453)		<0.0001
    2		1.654 (1.350–2.027)		<0.0001
    Hemoglobin <12 g/dL (reference: ≥12 g/dL)		1.098 (0.993–1.213)		0.0686
    Tumor subgroups (reference: squamous)
    Adenocarcinoma		0.783 (0.698–0.877)		<0.0001
    Other		0.932 (0.725–1.199)		0.5855
    ECOG=Eastern Cooperative Oncology Group; HR=hazard ratio; RDI=relative dose intensity.