Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
or further. Three patients presented brain metastases. In 5 cases a molecular
test was done, finding in one case (20%) a KRAS mutation. Patients received
a first line treatment with platinum and etoposide in 8 cases (80%) with a
disease control rate of 50%. Nine patients received nivolumab and the PD-L1
status was never performed, while the patient treated with pembrolizumab
expressed PD-L1. Patients received a median number of 16 [IQR, 13-18] cycles,
6 showed a partial response (60%), 1 a stable disease (10%). Median PFS was
57 [24-57] weeks. Most of the patients stopped treatment due to disease
progression (n=4; 80%), only one for a pulmonary interstitial pneumonia.
Conclusion: Our findings suggest that the use of immune-checkpoint–
inhibitors in LCNEC could be explored in a larger cohort of patients. This
treatment could be considered in the scenario of a disease with limited
therapeutic strategy.
Keywords: Immune checkpoint inhibitors, large cell neuroendocrine
carcinoma
POSTER SESSION 1 - P1.07: SCLC/NEUROENDOCRINE TUMORS
DRUG TREATMENT ALONE AND IN COMBINATION WITH RADIOTHERAPY –
MONDAY, DECEMBER 5, 2016
P1.07-013 TREATMENT RELATED SIDE EFFECTS OF ORAL
TOPOTECAN IN SMALL CELL LUNG CANCER
Filip Popovic, Marko Jakopovic, Miroslav Samarzija, Branka Čučević, Suzana
Kukulj, Mihovil Roglić, Sanja Pleština
Department for Respiratory Diseases “Jordanovac”, University Hospital Center,
Zagreb/Croatia
Background: Lung cancer is the most common tumor in men and the second
most common tumor in woman according to the latest data available from
the Croatian National Cancer Registry. Approximately 20% of all lung cancers
are categorized as small cell lung cancer (SCLC). Topotecan is recommended
as second-line chemotherapy in treatment of SCLC. Topotecan can be
administrated orally with the same effectiveness as parenteral. Methods: The
aim of this study was to determine toxicity of oral topotecan in second line
of chemotherapy and to establish the frequency of drug related admissions.
Results: A total of 177 courses of therapy were administered to the 64
patients, 17 woman and 47 men, with SCLC patients ranging from 42 to 77
years with the mean age of 59.3. All the patients were treated in University
Hospital Centre Zagreb from January 2012 to October 2015. Included patients
had ECOG performance status of 0 or 1. Topotecan was administrated every 21
day, at the dose of 2.3 mg/m 2 /day, during 5 days. Average number of courses
received was 2.8. Of all included patients 17 of them (26.5%) were admitted
to hospital because of adverse events related to topotecan administration.
The majority of patient hospitalizations (11 patients, 16.9%) was due to
febrile neutropenia. Other reasons for hospitalization were severe diarrhea
in 4 patients (6.2%), pneumonia in 1 patient (1.5%) and severe electrolyte
imbalance in 1 patient (1.5%). Of 17 admissions to hospital 10 (58.9%) of
them were after application of first chemotherapy cycle, 3 (17.6%) after
second cycle and 4 (23.5%) after third cycle. Quantitative hematologic
toxicities were assessed using the National Cancer Institute Common Toxicity
Criteria. Anemia grade 3 or 4 occurred in 13 patients (20.3%). Grade 3 or 4
thrombocytpenia occurred in 7 patients (10.9%). Grade 3 or 4 neutropenia
occurred in 16 patients (25%). Of other, non-hematologic adverse effects
the most serious was grade 3 or 4 diarrhea that occurred in 5 patients (7.8%).
Conclusion: although admission of oral topotecan is well tolerated it is related
with high rate of hospitalizations due to myelotoxicity and gastrointestinal
toxicity during therapy.
Keywords: SCLC, topotecan, side effects
POSTER SESSION 1 - P1.07: SCLC/NEUROENDOCRINE TUMORS
DRUG TREATMENT ALONE AND IN COMBINATION WITH RADIOTHERAPY –
MONDAY, DECEMBER 5, 2016
P1.07-014 IMPACT OF CHEMOTHERAPY FOR SMALL CELL LUNG
CANCER IN THE THIRD LINE AND BEYOND, A SEER-MEDICARE
ANALYSIS
Sungjin Kim 1 , Camille Ragin 2 , Zhengjia Chen 1 , Madhusmita Behera 1 , Rathi
Pillai 1 , Conor Steuer 1 , Chandra Belani 3 , Fadlo Khuri 1 , Suresh Ramalingam 4 ,
Taofeek Owonikoko 5
1 Emory University, Atlanta/United States of America, 2 Fox Chase Cancer Center,
Philadelphia/PA/United States of America, 3 Penn State Hershey Cancer Institute,
Hershey/PA/United States of America, 4 Winship Cancer Institute, Emory University,
Atlanta/GA/United States of America, 5 Medical Oncology, Emory University
Winship Cancer Institute, Atlanta/United States of America
Background: While there is no approved third line chemotherapy option for
small cell lung cancer (SCLC), empiric use of chemotherapy is common in this
setting in the absence of supporting prospective data. In order to assess the
potential benefit and predictors of chemotherapy use beyond the second
line setting in SCLC, we analyzed the SEER-MEDICARE database. Methods:
We employed data of SCLC patients diagnosed between 1985 and 2005.
Univariate (UVA) association of line of chemotherapies with covariates was
examined with Wilcoxon rank-sum test, chi-square or Fisher’s exact test.
Multivariable (MVA) logistic regression analysis for line of therapy was
conducted using the following covariates: year of diagnosis, age, gender,
race, Medicare status, urban/rural location, and radiation. Survival functions
were estimated by the Kaplan-Meier method and the log-rank test was used
to assess for difference in overall survival (OS) stratified by line of therapy.
UVA and MVA survival analyses were carried out using the Cox proportional
hazards model. To further balance confounders between patients receiving
different lines of therapy, propensity scores were estimated using a MVA
logistic regression model to predict the receipt of 3rd line chemotherapy
based on relevant covariates. Propensity score analysis was further
conducted by including the estimated propensity score as a covariate in a
Cox proportional hazards model. All analyses were done using SAS 9.3 with
two-sided tests and a significant level of 0.05. Results: There were 47,351
patients with SCLC of which 23,535 (49.7 %) received chemotherapy and
10,887 (23%) received platinum-based chemotherapy. Of the platinumtreated
patients, 1424 (13.1%) received additional salvage therapy of either
topotecan alone (n=801) or topotecan and additional treatments as 3rd line
and beyond (n=623). The median OS was 11, 13, 15 and 17 months respectively
for patients treated with one, two, three or > 3 lines of chemotherapy
respectively. Propensity score analysis showed additional lines of therapy
beyond the second line was associated with a reduced risk of death (HR: 0.786;
0.729 - 0.847, p