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P2.01-037 Clinical Impact of Interstitial Lung Disease on Advanced Non-Small Cell Lung Cancer
November 2017
Abstracts
Patient Characteristics Age (years) Sex (male / female) Stage IIIB (%) IV (%) Performance Status 0-1 (%) 2 (%) Smoking Never (%) Former (%) Current (%) Amounts (pack years) FEV1 (mL)
78.16 ± 4.72 18 / 1 6 (31.58) 13 (68.42) 15 (78.95) 4 (21.05) 1 (5.26) 13 (68.42) 5 (26.32) 49.05 ± 28.22 1.53 ± 0.53
P2.01-036 Symptom Trajectories During Chemotherapy Predict Overall Survival in Patients with Advanced Non-Small Cell Lung Cancer Q. Shi,1 X. Wang,1 L. Williams,1 T. Mendoza,1 G. Simon,2 C. Cleeland1 1Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX/US, 2Thoracic Medical Oncology, MD Anderson Cancer Center, Houston, TX/US Background: Patientereported symptoms have shown prognostic value for patients with advanced non-small-cell lung cancer (NSCLC). The value of persistently high levels of critical symptoms during chemotherapy for predicting survival is seldom addressed. We examined symptom trajectories during first 15 weeks of chemotherapy and their relations to 3-year overall survival (OS) in patients with advanced NSCLC. Method: Stage IIIB-IV NSCLC patients scheduled to receive either intravenous chemotherapy or the oral tyrosine kinase inhibitor erlotinib were enrolled in a multicenter longitudinal study. Patients rated 15 symptoms on the MD Anderson Symptom Inventory-Lung (MDASI-LC) before chemotherapy and weekly thereafter for 15 weeks, on 0-10 severity scales. Group-based trajectory analysis was used to categorize patients into groups according to the level and trajectory of symptom severity (either high or low) that patients experienced over time. The 3-year OS was compared between high/low groups via Kaplan-Meier analysis. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) were estimated by Cox regression modeling, with adjustment for demographic and clinical factors. Result: We analyzed data from 140 patients (90 died by end of study). Highseverity trajectories of three symptoms (fatigue, shortness of breath (SOB), lack of appetite (LOA)) significantly predicted 3-year OS. Patients in the high-fatigue group (n¼60) began with moderate fatigue (4.1±3.4) that increased significantly during weeks 1-4 of therapy (5.7±4.5 at week 4; estimated weekly change¼0.33, p¼0.0004) and remained at this level to week 15. Compared with patients in the low-fatigue group (mean¼2.0±1.8, no significant change over time), high-fatigue patients had shorter OS (median¼290 vs. 623 days, HR¼2.3, 95%CI¼1.4-3.8, p¼0.001). The high-SOB group (n¼62) maintained a moderate level of SOB (4.6±3.5) over 15 weeks and had lower 3-year OS rate than did patients in the low-SOB group (median¼256 vs. 566 days; HR¼2.7, 95% CI¼1.6-4.4, p<0.0001). Compared with patients in the low-LOA group (n¼66, mean¼0.8±1.8, no change over time), high-LOA patients (n¼74, mean¼3.2±3.1, no change over time) had shorter OS (median¼261 vs. 566 days, p¼0.019). The prognostic value of LOA was insignificant after adjusting for other factors. Conclusion: Our results suggest that, through longitudinal patient-reported symptom profiling during chemotherapy, persistently high symptom burden can independently predict overall survival in patients with advanced NSCLC. Patients with persistently high symptoms should be targeted for alerts to providers about the need for symptom control during chemotherapy in routine care for advanced
S2083
NSCLC. Such information could also be used as reference parameters for clinical trial/research design. Keywords: longitudinal symptom monitoring, Patient-reported outcomes, overall survival
P2.01-037 Clinical Impact of Interstitial Lung Disease on Advanced Non-Small Cell Lung Cancer H. Oi, H. Taniguchi, Y. Kondoh, T. Kimura, K. Kataoka, T. Matsuda, T. Yokoyama Respiratory Medicine and Allergy, Tosei General Hospital, Seto/JP Background: The advanced non-small cell lung cancer (NSCLC) is well known of poor survival. The advanced NSCLC patients with interstitial lung disease (ILD) to be expected poorer survival. The clinical features of patients with advanced NSCLC and interstitial lung disease (ILD) are not fully elucidated, and the role of chemotherapy in advanced NSCLC with ILD remain controversial. The aim of this study was to investigate the prevalence and clinical features of advanced NSCLC patients with ILD, particularly with idiopathic pulmonary fibrosis (IPF). Method: We retrospectively analyzed the patients diagnosed with advanced (i.e. stage IIIB and IV) NSCLC at Tosei general hospital, from January 2008 to December 2014. The diagnosis of ILD and IPF were made according to the 2013 and 2011 research statement respectively. Result: A total of 899 patients of lung cancer were reviewed, 282 patients were advanced NSCLC. Of these 282 patients, 34 (12%) received the diagnosis of ILD. 22 NSCLC patients (8%) had IPF in 34 ILD. 199/248 of non-ILD NSCLC patients (80%) and 26/34 of ILD NSCLC patients (76%), which includes 17 IPF patients, received chemotherapy. 49/248 (20%) of non-ILD NSCLC and 8 (24%) of ILD NSCLC were treated with best supportive care. There was no significant difference in disease control rate and objective response rate between non-ILD NSCLC and ILD NSCLC patients (72% vs 77%, p¼0.696; 33% vs 23%, p¼0.271). Overall survival in patients with ILD NSCLC was significantly worse than that in non-ILD NSCLC patients (median survival, 7 months vs 10.1 months; log-rank P¼0.013). In patients who received chemotherapy, ILD NSCLC patients had significantly worse survival than non-ILD NSCLC patients (median survival, 7 months vs 10.1 months; log-rank P¼0.013). However, there were no significant difference in overall survivals in ILD NSCLC patients between IPF and non-IPF (median survival, IPF-NSCLC vs non-IPF NSCLC: 6.1 months vs 8.2 months; logrank P¼0.375). Among ILD NSCLC patients who received chemotherapy, we found no significant difference in overall survival between IPF NSCLC and non-IPF (median survival, 9.6 months vs 9.7 months; log-rank P¼0.275). Conclusion: Among advanced NSCLC patients in this cohort, 12% of them had a diagnosis of ILD including 8% with IPF. Survival in advanced NSCLC patients with ILD was worse than that without ILD. We found no significant difference between ILD NSCLC patients with IPF or without IPF in survival. Keywords: Advanced NonSmall Cell Lung Cancer, interstitial lung disease
P2.01-038 Determinants of Frailty and Treatment Toxicity in Non-Small Cell Lung Cancer Patient M. Boucher,1 L. Mezquita,2 E. Auclin,3 M. Mons,4 J. Marghadi,4 M. Charrier,4 R. Ferrara,2 D. Planchard,5 G. Anas,1 C. Le Pechoux,6 A. Botticella,7 C. Caramella,4 J. Adam,8 J. Soria,9 B. Besse1 1Medical Oncology, Institut Gustave Roussy, Villejuif/FR, 2Medical Oncology Department, Gustave Roussy, Villejuif/FR, 3Hôpital Georges Pompidou, Paris/FR, 4Gustave Roussy, Villejuif/FR, 5Medical Oncology, Gustave Roussy, Villejuif/FR, 6Radiation Oncology, Gustave Roussy, Villejuif/FR, 7 Radiotherapy, Gustave Roussy, Villejuif/FR, 8Department of Medical Biology and Pathology, Gustave Roussy Cancer Campus, Villejuif/FR, 9 Drug Development Department, Gustave Roussy Cancer Campus, Paris/FR
Abstracts
Patient Characteristics Age (years) Sex (male / female) Stage IIIB (%) IV (%) Performance Status 0-1 (%) 2 (%) Smoking Never (%) Former (%) Current (%) Amounts (pack years) FEV1 (mL)
78.16 ± 4.72 18 / 1 6 (31.58) 13 (68.42) 15 (78.95) 4 (21.05) 1 (5.26) 13 (68.42) 5 (26.32) 49.05 ± 28.22 1.53 ± 0.53
P2.01-036 Symptom Trajectories During Chemotherapy Predict Overall Survival in Patients with Advanced Non-Small Cell Lung Cancer Q. Shi,1 X. Wang,1 L. Williams,1 T. Mendoza,1 G. Simon,2 C. Cleeland1 1Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX/US, 2Thoracic Medical Oncology, MD Anderson Cancer Center, Houston, TX/US Background: Patientereported symptoms have shown prognostic value for patients with advanced non-small-cell lung cancer (NSCLC). The value of persistently high levels of critical symptoms during chemotherapy for predicting survival is seldom addressed. We examined symptom trajectories during first 15 weeks of chemotherapy and their relations to 3-year overall survival (OS) in patients with advanced NSCLC. Method: Stage IIIB-IV NSCLC patients scheduled to receive either intravenous chemotherapy or the oral tyrosine kinase inhibitor erlotinib were enrolled in a multicenter longitudinal study. Patients rated 15 symptoms on the MD Anderson Symptom Inventory-Lung (MDASI-LC) before chemotherapy and weekly thereafter for 15 weeks, on 0-10 severity scales. Group-based trajectory analysis was used to categorize patients into groups according to the level and trajectory of symptom severity (either high or low) that patients experienced over time. The 3-year OS was compared between high/low groups via Kaplan-Meier analysis. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) were estimated by Cox regression modeling, with adjustment for demographic and clinical factors. Result: We analyzed data from 140 patients (90 died by end of study). Highseverity trajectories of three symptoms (fatigue, shortness of breath (SOB), lack of appetite (LOA)) significantly predicted 3-year OS. Patients in the high-fatigue group (n¼60) began with moderate fatigue (4.1±3.4) that increased significantly during weeks 1-4 of therapy (5.7±4.5 at week 4; estimated weekly change¼0.33, p¼0.0004) and remained at this level to week 15. Compared with patients in the low-fatigue group (mean¼2.0±1.8, no significant change over time), high-fatigue patients had shorter OS (median¼290 vs. 623 days, HR¼2.3, 95%CI¼1.4-3.8, p¼0.001). The high-SOB group (n¼62) maintained a moderate level of SOB (4.6±3.5) over 15 weeks and had lower 3-year OS rate than did patients in the low-SOB group (median¼256 vs. 566 days; HR¼2.7, 95% CI¼1.6-4.4, p<0.0001). Compared with patients in the low-LOA group (n¼66, mean¼0.8±1.8, no change over time), high-LOA patients (n¼74, mean¼3.2±3.1, no change over time) had shorter OS (median¼261 vs. 566 days, p¼0.019). The prognostic value of LOA was insignificant after adjusting for other factors. Conclusion: Our results suggest that, through longitudinal patient-reported symptom profiling during chemotherapy, persistently high symptom burden can independently predict overall survival in patients with advanced NSCLC. Patients with persistently high symptoms should be targeted for alerts to providers about the need for symptom control during chemotherapy in routine care for advanced
S2083
NSCLC. Such information could also be used as reference parameters for clinical trial/research design. Keywords: longitudinal symptom monitoring, Patient-reported outcomes, overall survival
P2.01-037 Clinical Impact of Interstitial Lung Disease on Advanced Non-Small Cell Lung Cancer H. Oi, H. Taniguchi, Y. Kondoh, T. Kimura, K. Kataoka, T. Matsuda, T. Yokoyama Respiratory Medicine and Allergy, Tosei General Hospital, Seto/JP Background: The advanced non-small cell lung cancer (NSCLC) is well known of poor survival. The advanced NSCLC patients with interstitial lung disease (ILD) to be expected poorer survival. The clinical features of patients with advanced NSCLC and interstitial lung disease (ILD) are not fully elucidated, and the role of chemotherapy in advanced NSCLC with ILD remain controversial. The aim of this study was to investigate the prevalence and clinical features of advanced NSCLC patients with ILD, particularly with idiopathic pulmonary fibrosis (IPF). Method: We retrospectively analyzed the patients diagnosed with advanced (i.e. stage IIIB and IV) NSCLC at Tosei general hospital, from January 2008 to December 2014. The diagnosis of ILD and IPF were made according to the 2013 and 2011 research statement respectively. Result: A total of 899 patients of lung cancer were reviewed, 282 patients were advanced NSCLC. Of these 282 patients, 34 (12%) received the diagnosis of ILD. 22 NSCLC patients (8%) had IPF in 34 ILD. 199/248 of non-ILD NSCLC patients (80%) and 26/34 of ILD NSCLC patients (76%), which includes 17 IPF patients, received chemotherapy. 49/248 (20%) of non-ILD NSCLC and 8 (24%) of ILD NSCLC were treated with best supportive care. There was no significant difference in disease control rate and objective response rate between non-ILD NSCLC and ILD NSCLC patients (72% vs 77%, p¼0.696; 33% vs 23%, p¼0.271). Overall survival in patients with ILD NSCLC was significantly worse than that in non-ILD NSCLC patients (median survival, 7 months vs 10.1 months; log-rank P¼0.013). In patients who received chemotherapy, ILD NSCLC patients had significantly worse survival than non-ILD NSCLC patients (median survival, 7 months vs 10.1 months; log-rank P¼0.013). However, there were no significant difference in overall survivals in ILD NSCLC patients between IPF and non-IPF (median survival, IPF-NSCLC vs non-IPF NSCLC: 6.1 months vs 8.2 months; logrank P¼0.375). Among ILD NSCLC patients who received chemotherapy, we found no significant difference in overall survival between IPF NSCLC and non-IPF (median survival, 9.6 months vs 9.7 months; log-rank P¼0.275). Conclusion: Among advanced NSCLC patients in this cohort, 12% of them had a diagnosis of ILD including 8% with IPF. Survival in advanced NSCLC patients with ILD was worse than that without ILD. We found no significant difference between ILD NSCLC patients with IPF or without IPF in survival. Keywords: Advanced NonSmall Cell Lung Cancer, interstitial lung disease
P2.01-038 Determinants of Frailty and Treatment Toxicity in Non-Small Cell Lung Cancer Patient M. Boucher,1 L. Mezquita,2 E. Auclin,3 M. Mons,4 J. Marghadi,4 M. Charrier,4 R. Ferrara,2 D. Planchard,5 G. Anas,1 C. Le Pechoux,6 A. Botticella,7 C. Caramella,4 J. Adam,8 J. Soria,9 B. Besse1 1Medical Oncology, Institut Gustave Roussy, Villejuif/FR, 2Medical Oncology Department, Gustave Roussy, Villejuif/FR, 3Hôpital Georges Pompidou, Paris/FR, 4Gustave Roussy, Villejuif/FR, 5Medical Oncology, Gustave Roussy, Villejuif/FR, 6Radiation Oncology, Gustave Roussy, Villejuif/FR, 7 Radiotherapy, Gustave Roussy, Villejuif/FR, 8Department of Medical Biology and Pathology, Gustave Roussy Cancer Campus, Villejuif/FR, 9 Drug Development Department, Gustave Roussy Cancer Campus, Paris/FR