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165: A retrospective survey of outcomes for patients diagnosed with small cell lung cancer in Leicester
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Poster abstracts, 13th Annual British Thoracic Oncology Group Conference, 2015: Small Cell Lung Cancer
on treatment and prognosis, at Portsmouth Hospital Trust from December 2012 to December 2013 (N = 45). Methods: Data was sourced from our oncology multi-disciplinary team database, clinic letters and biochemistry/microbiology reporting system. Results: Hyponatraemia (<135 mmol/l) was present in 58% of patients, and severe hyponatraemia (<125 mmol/l) was present in 9% of patients. Hyponatraemia was associated with a shorter median survival of 260 days compared to 352 in patients with normal serum sodium (p = 0.99). Performance status deteriorated in 30% of hyponatraemic patients from the time of their diagnosis to their oncology outpatient appointment; compared to 16% of those with a normal serum sodium. Chemotherapy was used to treat a higher proportion of patients with normal serum sodium (84%) than hyponatraemic patients (80%). Similarly, a larger quota of patients with normal serum sodium received radiotherapy (74%) than hyponatraemic patients (62%). Both groups were primarily treated with targeted lung tumour radiation with prophylactic cranial irradiation (PCI) (50%). 18% of all patients presented with extensive stage disease and received palliative care. Conclusion: Hyponatraemia in SCLC is a poor prognostic indicator. Our data supports this trend with hyponatraemia being associated with shorter survival and rapid deterioration in performance status, although results were not statistically significant. Standard practice involves treatment of severe hyponatraemia (<125 mmol/l) with demeclocycline. Fluid restriction as first line management in SCLC patients is not well tolerated. Tolvaptan is a novel therapy providing fast effective treatment. Portsmouth Hospital Trust policy now treats all patients with serum sodium <130 mmol/l with tolvaptan. This aims to target moderate and severe hyponatraemia from the outset and improve outcomes. Disclosure: All authors have declared no conflicts of interest. 165 A retrospective survey of outcomes for patients diagnosed with small cell lung cancer in Leicester M. Chauhan1 , N. Ma2 *, S. Ahmed1 . 1 Medical Oncology, Leicester Royal Infirmary, Leicester, United Kingdom, 2 Clinical Oncology, Leicester Royal Infirmary, Leicester, United Kingdom Introduction: Small cell lung cancer (SCLC) is an aggressive, chemosensitive tumour with a poor prognosis without chemotherapy. Palliative chemotherapy gives symptomatic relief and increases the survival of patients. Methods: Pathologically confirmed SCLC cases in 2013 were identified from the lung multi-disciplinary-team meetings, and treatment recommendations were explored. Chemotherapy received was identified. Admissions during treatment, dose modifications, delays and chemotherapy completion data were reviewed. Dates of death were obtained and the survival data from diagnosis was calculated. Table: Survival data for patients diagnosed with SCLC in Leicester in 2013
No oncology treatment Radiotherapy alone Carboplatin & etoposide Cisplatin & etoposide Overall population
No. of patients
Survival (months) Range Mean
Median
7 2 26 6 41
0.3 0.7 1.8 2.1 0.5 23.8 4 15.3 0.3 23.8
0.5 2.0 9.2 12 9.2
0.5 2.0
Results: 41 patients were diagnosed with SCLC in Leicester in 2013. 9 (22%) did not have chemotherapy. Of these, 2 patients received radiotherapy alone and the remaining 7 died before any treatment started. The mean time between first abnormal imaging to treatment was 32 days, with a range of 2 to 77 days. 32 (78%) patients had chemotherapy. The mean time from biopsy to
commencement of chemotherapy was 20 days. 26 (81%) of these had Carboplatin and Etoposide and 6 (19%) had Cisplatin and Etoposide. 19 (59%) required admission during chemotherapy. 20 (63%) had their chemotherapy delayed at least once. 22 (69%) required a dose reduction. 20 patients completed their prescribed courses of treatment, giving a 63% completion rate. To date, 25 (61%) patients have died and 16 (39%) are still alive. The survival ranged from 9 days to 24 months after diagnosis. Conclusion: According to national statistics, the estimated survival for patients with extensive stage SCLC is 2 4 months without chemotherapy. With chemotherapy this is extended to 6 12 months. In this survey we have shown that the median survival is 9.2 12 months after chemotherapy, in line with the data. Patients who received the Cisplatin regime had an improved survival. This could be due to the bias of selecting patients for this regime with a good performance status. Our survey also demonstrates that chemotherapy is effective in improving outcomes. Disclosure: All authors have declared no conflicts of interest. 166 REST a Dutch/UK randomized phase III trial on the use of thoracic radiotherapy in extensive stage small-cell lung cancer C. Faivre-Finn1 *, M.Q. Hatton2 , M. Snee3 , P. Jain4 , P. Wilson5 , R. McMenemin6 , C. Peedell7 , A. Bates8 , A. Garcia9 , J. Ironside10 , S. Falk1 , H. Van Tinteren11 , A. Keijser12 , B.J. Slotman13 . 1 MAHSC-CTU, The Christie NHS Foundation Trust, Manchester, United Kingdom, 2 Clinical Oncology, Weston Park Hospital, Sheffield, United Kingdom, 3 Clinical Oncology, St James’s University Hospital, Leeds, United Kingdom, 4 Clinical Oncology, Clatterbridge Centre for Oncology, Wirral, United Kingdom, 5 Clinical Oncology, Bristol Haematology & Oncology Centre, Bristol, United Kingdom, 6 Northern Centre for Cancer Care, Freeman Hospital, Newcastleupon-Tyne, United Kingdom, 7 Clinical Oncology, The James Cook University Hospital, Middlesbrough, United Kingdom, 8 Clinical Oncology, Southampton General Hospital, Southampton, United Kingdom, 9 Clinical Oncology, Glan Clwyd Hospital, Rhyl, United Kingdom, 10 Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom, 11 Biometrics Department, Netherlands Cancer Institute, Amsterdam, Netherlands, 12 IKNL Clinical Research Department, Integraal Kankercentrum Nederland, Amsterdam, Netherlands, 13 Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands Introduction: A majority of patients with extensive stage small-cell lung cancer (ES-SCLC) who undergo chemotherapy and prophylactic cranial irradiation (PCI), have persistent intrathoracic disease. This randomized study, evaluated the role thoracic radiotherapy (TRT) in this patient group. Methods: Patients (WHO 0 2) with confirmed ES-SCLC with a response after 4 6 cycles of standard chemotherapy were randomized to receive TRT (30 Gy/10 fractions) or no TRT. All received PCI. Primary study endpoint was overall survival. Acute toxicity was graded using CTCAE v3.0. The study had 80% power to detect a hazard ratio of 0.76 at 1 year. Analysis was based on intent to treat. Results: Between February 2009 and December 2012, 498 patients were enrolled (143 patients from the UK); Median follow-up was 24 months. 88% had residual intrathoracic disease. Baseline characteristics were well balanced. Mean age was 63 year (36 85), 89% had WHO 0 1; 11% WHO2. Mean interval between start of chemotherapy and randomization was 16 weeks. In the TRT arm, 5 patients did not receive TRT due to progression or refusal. No severe toxicities were observed. At the time of analysis (December 2013), 76 patients were still alive. Progression-free survival was longer in the TRT-arm (HR=0.73, CI 0.61 0.87; p = 0.001). Curves for overall survival overlapped during the first 9 months and then diverged in
Poster abstracts, 13th Annual British Thoracic Oncology Group Conference, 2015: Small Cell Lung Cancer
on treatment and prognosis, at Portsmouth Hospital Trust from December 2012 to December 2013 (N = 45). Methods: Data was sourced from our oncology multi-disciplinary team database, clinic letters and biochemistry/microbiology reporting system. Results: Hyponatraemia (<135 mmol/l) was present in 58% of patients, and severe hyponatraemia (<125 mmol/l) was present in 9% of patients. Hyponatraemia was associated with a shorter median survival of 260 days compared to 352 in patients with normal serum sodium (p = 0.99). Performance status deteriorated in 30% of hyponatraemic patients from the time of their diagnosis to their oncology outpatient appointment; compared to 16% of those with a normal serum sodium. Chemotherapy was used to treat a higher proportion of patients with normal serum sodium (84%) than hyponatraemic patients (80%). Similarly, a larger quota of patients with normal serum sodium received radiotherapy (74%) than hyponatraemic patients (62%). Both groups were primarily treated with targeted lung tumour radiation with prophylactic cranial irradiation (PCI) (50%). 18% of all patients presented with extensive stage disease and received palliative care. Conclusion: Hyponatraemia in SCLC is a poor prognostic indicator. Our data supports this trend with hyponatraemia being associated with shorter survival and rapid deterioration in performance status, although results were not statistically significant. Standard practice involves treatment of severe hyponatraemia (<125 mmol/l) with demeclocycline. Fluid restriction as first line management in SCLC patients is not well tolerated. Tolvaptan is a novel therapy providing fast effective treatment. Portsmouth Hospital Trust policy now treats all patients with serum sodium <130 mmol/l with tolvaptan. This aims to target moderate and severe hyponatraemia from the outset and improve outcomes. Disclosure: All authors have declared no conflicts of interest. 165 A retrospective survey of outcomes for patients diagnosed with small cell lung cancer in Leicester M. Chauhan1 , N. Ma2 *, S. Ahmed1 . 1 Medical Oncology, Leicester Royal Infirmary, Leicester, United Kingdom, 2 Clinical Oncology, Leicester Royal Infirmary, Leicester, United Kingdom Introduction: Small cell lung cancer (SCLC) is an aggressive, chemosensitive tumour with a poor prognosis without chemotherapy. Palliative chemotherapy gives symptomatic relief and increases the survival of patients. Methods: Pathologically confirmed SCLC cases in 2013 were identified from the lung multi-disciplinary-team meetings, and treatment recommendations were explored. Chemotherapy received was identified. Admissions during treatment, dose modifications, delays and chemotherapy completion data were reviewed. Dates of death were obtained and the survival data from diagnosis was calculated. Table: Survival data for patients diagnosed with SCLC in Leicester in 2013
No oncology treatment Radiotherapy alone Carboplatin & etoposide Cisplatin & etoposide Overall population
No. of patients
Survival (months) Range Mean
Median
7 2 26 6 41
0.3 0.7 1.8 2.1 0.5 23.8 4 15.3 0.3 23.8
0.5 2.0 9.2 12 9.2
0.5 2.0
Results: 41 patients were diagnosed with SCLC in Leicester in 2013. 9 (22%) did not have chemotherapy. Of these, 2 patients received radiotherapy alone and the remaining 7 died before any treatment started. The mean time between first abnormal imaging to treatment was 32 days, with a range of 2 to 77 days. 32 (78%) patients had chemotherapy. The mean time from biopsy to
commencement of chemotherapy was 20 days. 26 (81%) of these had Carboplatin and Etoposide and 6 (19%) had Cisplatin and Etoposide. 19 (59%) required admission during chemotherapy. 20 (63%) had their chemotherapy delayed at least once. 22 (69%) required a dose reduction. 20 patients completed their prescribed courses of treatment, giving a 63% completion rate. To date, 25 (61%) patients have died and 16 (39%) are still alive. The survival ranged from 9 days to 24 months after diagnosis. Conclusion: According to national statistics, the estimated survival for patients with extensive stage SCLC is 2 4 months without chemotherapy. With chemotherapy this is extended to 6 12 months. In this survey we have shown that the median survival is 9.2 12 months after chemotherapy, in line with the data. Patients who received the Cisplatin regime had an improved survival. This could be due to the bias of selecting patients for this regime with a good performance status. Our survey also demonstrates that chemotherapy is effective in improving outcomes. Disclosure: All authors have declared no conflicts of interest. 166 REST a Dutch/UK randomized phase III trial on the use of thoracic radiotherapy in extensive stage small-cell lung cancer C. Faivre-Finn1 *, M.Q. Hatton2 , M. Snee3 , P. Jain4 , P. Wilson5 , R. McMenemin6 , C. Peedell7 , A. Bates8 , A. Garcia9 , J. Ironside10 , S. Falk1 , H. Van Tinteren11 , A. Keijser12 , B.J. Slotman13 . 1 MAHSC-CTU, The Christie NHS Foundation Trust, Manchester, United Kingdom, 2 Clinical Oncology, Weston Park Hospital, Sheffield, United Kingdom, 3 Clinical Oncology, St James’s University Hospital, Leeds, United Kingdom, 4 Clinical Oncology, Clatterbridge Centre for Oncology, Wirral, United Kingdom, 5 Clinical Oncology, Bristol Haematology & Oncology Centre, Bristol, United Kingdom, 6 Northern Centre for Cancer Care, Freeman Hospital, Newcastleupon-Tyne, United Kingdom, 7 Clinical Oncology, The James Cook University Hospital, Middlesbrough, United Kingdom, 8 Clinical Oncology, Southampton General Hospital, Southampton, United Kingdom, 9 Clinical Oncology, Glan Clwyd Hospital, Rhyl, United Kingdom, 10 Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom, 11 Biometrics Department, Netherlands Cancer Institute, Amsterdam, Netherlands, 12 IKNL Clinical Research Department, Integraal Kankercentrum Nederland, Amsterdam, Netherlands, 13 Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands Introduction: A majority of patients with extensive stage small-cell lung cancer (ES-SCLC) who undergo chemotherapy and prophylactic cranial irradiation (PCI), have persistent intrathoracic disease. This randomized study, evaluated the role thoracic radiotherapy (TRT) in this patient group. Methods: Patients (WHO 0 2) with confirmed ES-SCLC with a response after 4 6 cycles of standard chemotherapy were randomized to receive TRT (30 Gy/10 fractions) or no TRT. All received PCI. Primary study endpoint was overall survival. Acute toxicity was graded using CTCAE v3.0. The study had 80% power to detect a hazard ratio of 0.76 at 1 year. Analysis was based on intent to treat. Results: Between February 2009 and December 2012, 498 patients were enrolled (143 patients from the UK); Median follow-up was 24 months. 88% had residual intrathoracic disease. Baseline characteristics were well balanced. Mean age was 63 year (36 85), 89% had WHO 0 1; 11% WHO2. Mean interval between start of chemotherapy and randomization was 16 weeks. In the TRT arm, 5 patients did not receive TRT due to progression or refusal. No severe toxicities were observed. At the time of analysis (December 2013), 76 patients were still alive. Progression-free survival was longer in the TRT-arm (HR=0.73, CI 0.61 0.87; p = 0.001). Curves for overall survival overlapped during the first 9 months and then diverged in