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S. Lefresne
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P3.01 - Advanced NSCLC (ID 621)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 2
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.01-013 - CNS Metastases in EGFR Mutation Positive NSCLC: Impact on Health Resource Utilization (ID 8584)
09:30 - 09:30 | Author(s): S. Lefresne
- Abstract
Background:
EGFR mutation positive (EGFRm) NSCLC patients commonly progress in the CNS. We reviewed CNS disease development and its impact on resource utilization and outcomes in EGFRm patients who received first-line EGFR TKI.
Method:
Methods: A retrospective review was completed of all advanced EGFR+ patients referred to the BC Cancer Agency and treated with a first/second-generation EGFR TKI from 2010-2015. Baseline characteristics, systemic treatment and CNS management was collected. Comparison was made between the CNS positive (CNS+) and negative (CNS-) patients’ health resource utilization from median time of CNS+ diagnosis to death/last follow-up (8.9 m) and for no CNS metastases group, 9 months preceding death/last follow-up, using the Chi squared test and t-test.
Result:
499 patients were identified. Baseline characteristics: Female 68%, median age 66 (30-90), adenocarcinoma 89%, Asian 51%, never/former/current smoker 67/24/9%, exon 19/21/other/not specified 57/37/3/3%. 229/499 patients (46%) developed CNS+; 39% at diagnosis, 61% during the course of disease. Systemic treatment: first-line EGFR TKI 95%, first-line platinum doublet 5%; 40% (202/499) second-line EGFR TKI 24%, second -line platinum doublet 56%, single agent chemo 13%, osimertinib 7%, third-line therapy 47%. CNS+ management: surgery+/-WBXRT 13%, WBXRT alone 73%, SRS+/-WBXRT 5%, no CNS directed therapy 9%. Median time from diagnosis to CNS+ was 7.6 m. Median time from development of CNS+ diagnosis to death was 8.9 m. Median OS was 24m in CNS+ versus 33m in CNS- (p<0.001).Events in 9m preceding death or last follow-up (consistent with median time from CNS+ to death) No CNS Metastases n=270 CNS Metastases n=229 p value Average number of clinic visits 8.53 12.71 <0.001 Average number of hospitalizations 0.43 0.76 <0.001 Average number of CNS imaging investigations 0.52 2.65 <0.001 Average number of ER visits 0.03 0.14 0.001 Palliative Care Unit admission 22 (8%) 22 (10%) 0.64 Hospice admission 9 (3%) 43 (19%) <0.001
Conclusion:
The incidence of CNS+ in EGFRm patients is high and associated with increased Health Resource Utilization. Prevention or delay of CNS+ with newer systemic therapy options may result in decreased interactions with health care providers, which may translate into lower resource utilization and cost savings.
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P3.01-030 - CNS Metastases in EGFR Mutation Positive (EGFRm) NSCLC Patients: The Prognostic Relevance of Presenting Symptoms (ID 9135)
09:30 - 09:30 | Author(s): S. Lefresne
- Abstract
Background:
The overall survival (OS) of patients with EGFR mutation positive (EGFRm) lung cancer has changed dramatically due to the combined benefit of targeted systemic therapy, local management of oligometastatic disease and incorporation of judicious use of radiotherapy. We reviewed EGFRm NSCLC patients who were diagnosed with CNS metastasis to determine the prognostic importance of the initial CNS presentation.
Method:
A retrospective review was conducted of EGFR+ referred to the BC Cancer Agency between 2010 and 2015, treated with a first/second-generation EGFR TKI who developed CNS metastases (CNSm). Baseline characteristics, presenting symptoms and CNS-targeted treatment data was collected. Cox regression was conducted to determine the prognostic implications of the most common clinical presentations on OS.
Result:
229 patients were identified; 90 presented with CNSm and 139 developed CNSm during the course of their disease. Method of CNSm detection: CT only 61%, MRI only 8%, CT and MRI 30%, PET 1%. 80% of patients were symptomatic at CNSm diagnosis. Baseline characteristics: female 66%, median age 62 (34-90), Asian 51%, exon 19/exon 21/rare mutation/not specified 56/39/3/2%. CNS management: 13% surgery+/- whole brain radiotherapy (WBRT), 73% WBRT alone, 5% stereotactic radiosurgery (SRS)+/-WBRT, 9% no CNS directed therapy. OS was 21.6 months in patients who presented with CNSm vs. 27.1 months in those who developed CNSm during the course of disease (p=0.39). On multivariate analysis, the only presenting symptom associated with increased risk of death was cognitive dysfunction.Frequency of symptom at presentation Univariate Analysis Multivariate Analysis HR P value HR P value Cognitive Dysfunction 19% 1.26 0.01 1.21 0.04 Motor Dysfunction 18% 1.04 0.69 Balance and Ataxia 11% 1.04 0.46 Cranial Nerve Changes 8% 0.94 0.65 Headache and Dizziness 30% 0.94 0.41 Nausea and Vomiting 13% 0.92 0.48 Visual Disturbance 10% 0.99 0.97 Speech and Aphasia 10% 1.19 0.16 Seizures 7% 0.75 0.09 0.78 0.13 Leptomeningeal disease 12% 1.25 0.04 1.20 0.10
Conclusion:
The most common symptoms at initial presentation of CNSm in EGFRm patients were headache and dizziness, cognitive dysfunction and motor dysfunction. In multivariate analysis, only cognitive dysfunction was associated with poorer survival. Clinicians should have a low threshold for CNS screening based on the varied clinical symptoms experienced by patients
