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Pemetrexed versus Other Platinum-Based Regimens on Adjuvant Chemotherapy in Resected Adenocarcinoma Lung Cancer
S930
Yasunobu Kuraishi,2 Haruka Izumi2 1Division of Hematology & Oncology, Toho University Medical Center Oomori Hospital, Oota City/Japan, 2Division of Hematology and Oncology, Department of Medicine, Toho University Medical Center Oomori Hospital, Oota City/ Japan, 3Toho University Medical Center Oomori Hospital, Oota City/Japan Background: Therapy-related leukemia defined by the World health Organization 2008 classification scheme of hematolymphoid tumors including therapy-related acute myeloid neoplasms (t-AML), myelodysplastic syndrome (t-MDS). They occur as late complication of cytotoxic chemotherapy, radiation therapy and molecular target agents therapy against primary neoplasms. Recently, for lung cancer chemotherapy, new anti-cancer agent and molecular target agents are increased and more intensification chemotherapy performed. We report that we reviewed t-AML cases who survived from lung cancer and suffered t-AML. Methods: We intended for multiple neoplasms 339 cases including hematological malignancy. We reviewed 55 multiple neoplasms including the lung cancer. In 55 cases, second neoplasms that were t-AML cases were 4 cases, t-MDS case was 1 case. All patients were followed up until death or untile December 2015. Survival was measured from the diagnosis of multiple cancer to time of death or last contact. We investigated cytogenetic abnormality, therapy, clinical outcome, prognosis, and cause of death. Results: In 5 cases, 4 cases were diagnosed t-AML, 1 case was t-MDS. 5 of cases were 4 male and 1 female, primaly diagnosis were small cell carcinoma 2 cases, squamous carcinoma adenocarcinoma 3 cases. 1 case, One case (male case) was t-APL, he treated by all-trans retinoic acid and he reached complete response. T-M2 type, she treated by chemotherapy included daunorbicin and Ara-C (DC3-7), she did not achieve complete response. About prognosis, t-APL case, he lived 1 month after complete response, he died by lung cancer, t-AML cases, one female case, she lived 25 months after partial response, she died by t-AML relapse and refractory for salvage CTx. Other 3 cases, 1 case death by t-MDS, 2 cases death by t-AML. Conclusion: As the number of lung cancer survivors increased due to improvement in chemotherapy, clinician must more take attention of therapy-related leukemia and myelodysplastic syndrome by previous treatments. Keywords: chemotherapy, therapy-reated AML, therapyrelated MDS
Journal of Thoracic Oncology
Vol. 12 No. 1S
P2.03a-068 Impact of Platinum/Pemetrexed versus Other Platinum-Based Regimens on Adjuvant Chemotherapy in Resected Adenocarcinoma Lung Cancer Topic: Clinical Trials Xiaoyu Zhai,1 Wang Ziping,2 Lu Yang,3 Yixiang Zhu,1 Junling Li1 1Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing/China, 2Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing/China, 3Department of Medical Oncology, Peking Union Medical College, Beijing/China Background: Adjuvant chemotherapy improves the survival for completely resected non-small cell lung cancer (NSCLC) patients. Platinum/pemetrexed is known to be less toxicity, better compliance and longer survival in advanced non-squamous NSCLC, but the survival outcome compared with other regimens in adjuvant setting is still unknown. This report described the survival in adjuvant chemotherapy for lung adenocarcinoma with platinum/ pemetrexed versus other platinum-based doublets. Methods: 389 completely radical surgery lung adenocarcinoma patients who received adjuvant chemotherapy with platinum/pemetrexed regimen (Group A, n¼143) and non-pemetrexed platinum-based regimens (Group B, n¼246) were analyzed retrospectively. Primary end point was disease-free survival (DFS). Propensity score matching (PSM) allowed best matched pairs for platinum/pemetrexed versus other platinum-based doublets for comparison of survival and adverse events. Results: PSM created treatment groups for platinum/ pemetrexed versus non-pemetrexed regimen (125 pairs), docetaxel and paclitaxel (107 pairs), gemcitabine (56 pairs), and vinorelbine (24 pairs)-contained doublets, respectively. Although DFS was not significantly different between Group A and B (P¼0.1643) (Figure A), in 125 PSM pairs, DFS was considerably better in patients who received platinum/pemetrexed regimen (P¼0.0079)(Figure B). From the subgroup analysis, Pemetrexed benefit is consistent across different subgroups, and especially aging (>65) was associated with the decision to use platinum/pemetrexed (HR¼0.25,95% CI 0.09-0.73, P¼0,011). Furthermore, platinum/pemetrexed was associated with several significantly lower hematological and non-hematological AE rates, such as versus gemcitabine (Leukopenia: RR 0.514, p¼0.001;
January 2017
Neutropenia: RR 0.688, p¼0.002) and paclitaxel- and docetaxel-based chemotherapy (Leukopenia： RR 0.685, p¼0.019; Neutropenia: RR 0.805, p¼0.032).
Abstracts
S931
respectively 66%, 55% and 70% (p ¼ 0, 95). The PFS is respectively 50,4 and 57,3 months for the CISV and CISV/CBV groups and was not achieved for the CBV group (p ¼ 0,80). No differences were noted between groups concerning grade 3 or 4 hematologic toxicity. Conclusion: The effectiveness and hematologic toxicity are comparable between cisplatin and carboplatin in the adjuvant treatment of resected non-small cell lung cancer. The results obtained corroborate the practice used at our oncology clinic. Nevertheless, more prospective studies would be needed to confirm these results.
Conclusion: Adjuvant chemotherapy with platinum/ pemetrexed shows both better disease-free survival and less clinical toxicity than other non-pemetrexed based doublets in completely resected adenocarcinoma lung cancer. Keywords: pemetrexed, disease free survival, lung adenocarcinoma, adjuvant chemotherapy
P2.03a-069 Effectiveness of Adjuvant CarboplatinBased Chemotherapy Compared to Cisplatin in Resected Non-Small Cell Lung Cancer Topic: Clinical Trials Valerie Couillard-Montminy, Pierre-Yves Gagnon, Jimmy Cote Pharmacy, Iucpq, Quebec/QC/Canada Background: Cisplatin and vinorelbine given intravenously is a well-established adjuvant chemotherapy regimen after surgery for early NSCLC. However, few validated alternative exist when cisplatin is not indicated or tolerated. Carboplatin is frequently used in this setting. We evaluated the 5 years overall survival (OS), progression-free survival (PFS) and toxicity in patients treated for stage IB to IIIB resected NSCLC receiving adjuvant carboplatin based chemotherapy compared to cisplatin in association with vinorelbine. Methods: Single-center retrospective study of patients having received adjuvant chemotherapy between January 2004 and December 2013 at the oncology clinic at Institut de Cardiologie et de Pneumologie de Québec (Canada). Three sub-groups were studied: cisplatin / vinorelbine (CISV), carboplatin / vinorelbine (CBV) and the substitution of cisplatin /vinorelbine for carboplatin /vinorelbine during treatment. Results: A total of 127 patients were included in this study. The overall survival (OS) at 5 years and the median progression-free survival (PFS) did not differ significantly between groups. The 5 years OS is
Keywords: ADJUVANT, chemotherapy, Cisplatin, carboplatin
P2.03a-070 A Feasibility Study of Adjuvant Chemotherapy with Modified Weekly Nab-Paclitaxel and Carboplatin for Completely Resected NSCLC Topic: Clinical Trials Hisashi Saji, Hiroki Sakai, Yukihiro Kimura, Tomoyuki Miyazawa, Haruhiko Nakamura, Hideki Marushima Chest Surgery, St. Marianna University School of Medicine, Kanagawa/Japan Background: Albumin-bound paclitaxel (nab-paclitaxel) has been demonstrated to improve outcomes with lesser neuropathy compared to that with paclitaxel in patients with advanced non-small cell lung cancer (NSCLC). However, the feasibility of adjuvant chemotherapy setting is still uncertain. This phase II trial assessed the feasibility of adjuvant chemotherapy with nab-paclitaxel and carboplatin in patients who underwent complete resection of pathological stage IB/II/IIIA NSCLC (UMIN000011225). Methods: Patients with completely resected pathological stage IB/II/IIIA NSCLC were recruited from July, 2013. Patients were administered adjuvant chemotherapy with 4 cycles of carboplatin (AUC 5) on day 1 and nabpaclitaxel (100 mg/m2) on days 1 and 8 every 3 weeks. The primary endpoint was the completion of 3 cycles of chemotherapy. The sample size was set at 30 patients, and the treatment was considered feasible if the 80% CI of the completion rate of 3 cycles of chemotherapy was 60%, a¼0.05 and b¼0.2. Results: The study enrolled 30 patients including 2 pilot patients. The median relative dose intensities of modified weekly carboplatin and nab-paclitaxel were 80% and 70%, respectively. First two pilot patients were required dose reduction in conventional weekly carboplatin (AUC5) on day1 and nab-paclitaxel (100 mg/m2)
Yasunobu Kuraishi,2 Haruka Izumi2 1Division of Hematology & Oncology, Toho University Medical Center Oomori Hospital, Oota City/Japan, 2Division of Hematology and Oncology, Department of Medicine, Toho University Medical Center Oomori Hospital, Oota City/ Japan, 3Toho University Medical Center Oomori Hospital, Oota City/Japan Background: Therapy-related leukemia defined by the World health Organization 2008 classification scheme of hematolymphoid tumors including therapy-related acute myeloid neoplasms (t-AML), myelodysplastic syndrome (t-MDS). They occur as late complication of cytotoxic chemotherapy, radiation therapy and molecular target agents therapy against primary neoplasms. Recently, for lung cancer chemotherapy, new anti-cancer agent and molecular target agents are increased and more intensification chemotherapy performed. We report that we reviewed t-AML cases who survived from lung cancer and suffered t-AML. Methods: We intended for multiple neoplasms 339 cases including hematological malignancy. We reviewed 55 multiple neoplasms including the lung cancer. In 55 cases, second neoplasms that were t-AML cases were 4 cases, t-MDS case was 1 case. All patients were followed up until death or untile December 2015. Survival was measured from the diagnosis of multiple cancer to time of death or last contact. We investigated cytogenetic abnormality, therapy, clinical outcome, prognosis, and cause of death. Results: In 5 cases, 4 cases were diagnosed t-AML, 1 case was t-MDS. 5 of cases were 4 male and 1 female, primaly diagnosis were small cell carcinoma 2 cases, squamous carcinoma adenocarcinoma 3 cases. 1 case, One case (male case) was t-APL, he treated by all-trans retinoic acid and he reached complete response. T-M2 type, she treated by chemotherapy included daunorbicin and Ara-C (DC3-7), she did not achieve complete response. About prognosis, t-APL case, he lived 1 month after complete response, he died by lung cancer, t-AML cases, one female case, she lived 25 months after partial response, she died by t-AML relapse and refractory for salvage CTx. Other 3 cases, 1 case death by t-MDS, 2 cases death by t-AML. Conclusion: As the number of lung cancer survivors increased due to improvement in chemotherapy, clinician must more take attention of therapy-related leukemia and myelodysplastic syndrome by previous treatments. Keywords: chemotherapy, therapy-reated AML, therapyrelated MDS
Journal of Thoracic Oncology
Vol. 12 No. 1S
P2.03a-068 Impact of Platinum/Pemetrexed versus Other Platinum-Based Regimens on Adjuvant Chemotherapy in Resected Adenocarcinoma Lung Cancer Topic: Clinical Trials Xiaoyu Zhai,1 Wang Ziping,2 Lu Yang,3 Yixiang Zhu,1 Junling Li1 1Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing/China, 2Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing/China, 3Department of Medical Oncology, Peking Union Medical College, Beijing/China Background: Adjuvant chemotherapy improves the survival for completely resected non-small cell lung cancer (NSCLC) patients. Platinum/pemetrexed is known to be less toxicity, better compliance and longer survival in advanced non-squamous NSCLC, but the survival outcome compared with other regimens in adjuvant setting is still unknown. This report described the survival in adjuvant chemotherapy for lung adenocarcinoma with platinum/ pemetrexed versus other platinum-based doublets. Methods: 389 completely radical surgery lung adenocarcinoma patients who received adjuvant chemotherapy with platinum/pemetrexed regimen (Group A, n¼143) and non-pemetrexed platinum-based regimens (Group B, n¼246) were analyzed retrospectively. Primary end point was disease-free survival (DFS). Propensity score matching (PSM) allowed best matched pairs for platinum/pemetrexed versus other platinum-based doublets for comparison of survival and adverse events. Results: PSM created treatment groups for platinum/ pemetrexed versus non-pemetrexed regimen (125 pairs), docetaxel and paclitaxel (107 pairs), gemcitabine (56 pairs), and vinorelbine (24 pairs)-contained doublets, respectively. Although DFS was not significantly different between Group A and B (P¼0.1643) (Figure A), in 125 PSM pairs, DFS was considerably better in patients who received platinum/pemetrexed regimen (P¼0.0079)(Figure B). From the subgroup analysis, Pemetrexed benefit is consistent across different subgroups, and especially aging (>65) was associated with the decision to use platinum/pemetrexed (HR¼0.25,95% CI 0.09-0.73, P¼0,011). Furthermore, platinum/pemetrexed was associated with several significantly lower hematological and non-hematological AE rates, such as versus gemcitabine (Leukopenia: RR 0.514, p¼0.001;
January 2017
Neutropenia: RR 0.688, p¼0.002) and paclitaxel- and docetaxel-based chemotherapy (Leukopenia： RR 0.685, p¼0.019; Neutropenia: RR 0.805, p¼0.032).
Abstracts
S931
respectively 66%, 55% and 70% (p ¼ 0, 95). The PFS is respectively 50,4 and 57,3 months for the CISV and CISV/CBV groups and was not achieved for the CBV group (p ¼ 0,80). No differences were noted between groups concerning grade 3 or 4 hematologic toxicity. Conclusion: The effectiveness and hematologic toxicity are comparable between cisplatin and carboplatin in the adjuvant treatment of resected non-small cell lung cancer. The results obtained corroborate the practice used at our oncology clinic. Nevertheless, more prospective studies would be needed to confirm these results.
Conclusion: Adjuvant chemotherapy with platinum/ pemetrexed shows both better disease-free survival and less clinical toxicity than other non-pemetrexed based doublets in completely resected adenocarcinoma lung cancer. Keywords: pemetrexed, disease free survival, lung adenocarcinoma, adjuvant chemotherapy
P2.03a-069 Effectiveness of Adjuvant CarboplatinBased Chemotherapy Compared to Cisplatin in Resected Non-Small Cell Lung Cancer Topic: Clinical Trials Valerie Couillard-Montminy, Pierre-Yves Gagnon, Jimmy Cote Pharmacy, Iucpq, Quebec/QC/Canada Background: Cisplatin and vinorelbine given intravenously is a well-established adjuvant chemotherapy regimen after surgery for early NSCLC. However, few validated alternative exist when cisplatin is not indicated or tolerated. Carboplatin is frequently used in this setting. We evaluated the 5 years overall survival (OS), progression-free survival (PFS) and toxicity in patients treated for stage IB to IIIB resected NSCLC receiving adjuvant carboplatin based chemotherapy compared to cisplatin in association with vinorelbine. Methods: Single-center retrospective study of patients having received adjuvant chemotherapy between January 2004 and December 2013 at the oncology clinic at Institut de Cardiologie et de Pneumologie de Québec (Canada). Three sub-groups were studied: cisplatin / vinorelbine (CISV), carboplatin / vinorelbine (CBV) and the substitution of cisplatin /vinorelbine for carboplatin /vinorelbine during treatment. Results: A total of 127 patients were included in this study. The overall survival (OS) at 5 years and the median progression-free survival (PFS) did not differ significantly between groups. The 5 years OS is
Keywords: ADJUVANT, chemotherapy, Cisplatin, carboplatin
P2.03a-070 A Feasibility Study of Adjuvant Chemotherapy with Modified Weekly Nab-Paclitaxel and Carboplatin for Completely Resected NSCLC Topic: Clinical Trials Hisashi Saji, Hiroki Sakai, Yukihiro Kimura, Tomoyuki Miyazawa, Haruhiko Nakamura, Hideki Marushima Chest Surgery, St. Marianna University School of Medicine, Kanagawa/Japan Background: Albumin-bound paclitaxel (nab-paclitaxel) has been demonstrated to improve outcomes with lesser neuropathy compared to that with paclitaxel in patients with advanced non-small cell lung cancer (NSCLC). However, the feasibility of adjuvant chemotherapy setting is still uncertain. This phase II trial assessed the feasibility of adjuvant chemotherapy with nab-paclitaxel and carboplatin in patients who underwent complete resection of pathological stage IB/II/IIIA NSCLC (UMIN000011225). Methods: Patients with completely resected pathological stage IB/II/IIIA NSCLC were recruited from July, 2013. Patients were administered adjuvant chemotherapy with 4 cycles of carboplatin (AUC 5) on day 1 and nabpaclitaxel (100 mg/m2) on days 1 and 8 every 3 weeks. The primary endpoint was the completion of 3 cycles of chemotherapy. The sample size was set at 30 patients, and the treatment was considered feasible if the 80% CI of the completion rate of 3 cycles of chemotherapy was 60%, a¼0.05 and b¼0.2. Results: The study enrolled 30 patients including 2 pilot patients. The median relative dose intensities of modified weekly carboplatin and nab-paclitaxel were 80% and 70%, respectively. First two pilot patients were required dose reduction in conventional weekly carboplatin (AUC5) on day1 and nab-paclitaxel (100 mg/m2)