Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
EXTENSIVE DISEASE SMALL CELL LUNG CANCER PATIENTS
Hisao Imai 1 , Keita Mori 2 , Nodoka Watase 3 , Sakae Fujimoto 1 , Kyoichi Kaira 4 ,
Masanobu Yamada 5 , Koichi Minato 1
1 Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Gunma/
Japan, 2 Clinical Research Support Center, Shizuoka Cancer Center, Shizuoka/
Japan, 3 Division of Pharmacy, Gunma Prefectural Cancer Center, Gunma/Japan,
4 Department of Oncology Clinical Development, Gunma University Graduate
School of Medicine, Gunma/Japan, 5 Department of Medicine and Molecular
Science, Gunma University Graduate School of Medicine, Gunma/Japan
Background: The effects of first-line chemotherapy on overall survival (OS)
might be confounded by subsequent therapies in patients with small-cell
lung cancer (SCLC). Therefore, by using individual-level data, we aimed to
determine the relationships between progression-free survival (PFS) or
post-progression survival (PPS) and OS after first-line chemotherapies in
patients with extensive disease SCLC (ED-SCLC) treated with carboplatin
plus etoposide. Methods: Between July 1998 and December 2014, we analyzed
63 cases of patients with ED-SCLC who were treated with carboplatin and
etoposide as first-line chemotherapy. The relationships of PFS and PPS with
OS were analyzed at the individual level. Results: Spearman rank correlation
analysis and linear regression analysis showed that PPS was strongly
correlated with OS (r = 0.90, p < 0.05, R 2 = 0.71) and PFS was moderately
correlated with OS (r = 0.72, p < 0.05, R 2 = 0.62). Type of relapse (refractory/
sensitive) and the number of regimens administered after disease progression
after the first-line chemotherapy were both significantly associated with
PPS (p < 0.05). Conclusion: PPS has a stronger relationship with OS than
does PFS in ED-SCLC patients who have received first-line chemotherapy. In
addition, type of relapse (refractory/sensitive) after first-line treatment and
the number of additional regimens after first-line treatment are significant
independent prognostic factors for PPS. These results suggest that
treatments administered after first-line chemotherapy affect the OS of ED-
SCLC patients treated with carboplatin plus etoposide.
Keywords: overall survival, post-progression survival, Progression-free
survival, extensive disease small cell lung cancer
POSTER SESSION 1 - P1.07: SCLC/NEUROENDOCRINE TUMORS
SCLC/NEUROENDOCRINE TUMORS IN GENERAL –
MONDAY, DECEMBER 5, 2016
P1.07-049 LIMITED STAGE SMALL CELL LUNG CANCER: PATTERNS
OF CARE AND OUTCOMES OF A SINGLE INSTITUTION OVER 15
YEARS
Eunji Hwang 1 , Janet Williams 1 , Rebecca Venchiarutti 1 , Craig Lewis 2 , Wenchang
Wong 1
1 Radiation Oncology, Prince of Wales Hospital, Randwick/NSW/Australia, 2 Medical
Oncology, Prince of Wales Hospital, Randwick/NSW/Australia
Background: The past two decades have seen an increase in survival of
patients with limited stage small cell lung cancer (SCLC). This retrospective
audit analysed patterns of care, toxicity and survival for all patients with
limited stage SCLC diagnosed and treated at Prince of Wales hospital over
15 years. Our results were compared with the literature to assess this single
institution’s performance and outcomes, and explore what factors may most
be influencing these results. Methods: We identified 120 patients diagnosed
with SCLC at Prince of Wales Hospital between 2000 and 2014 from the
departmental electronic patient information system (Mosaiq). Eligibility
criteria were: age >18 years, histopathologically confirmed diagnosis of
SCLC, limited stage according to the two-stage Veterans’ Affairs Lung Study
Group staging criteria (2016), and treatment with either curative or palliative
intent. Median progression free survival (PFS), cancer specific survival (CSS)
and overall survival (OS) were estimated using the Kaplan-Meier method
and log-rank test (IBM SPSS version 23.0). Results: Thirty-two patients
fulfilled the eligibility criteria. The median age of patients was 66.5 years; 19
(59%) patients were female and 50% had an Eastern Cooperative Oncology
Group (ECOG) score of 0. Median PFS, CSS and OS were 12.6, 22.1 and 18.0
months respectively, comparable with published literature. Ten patients
(31%) received prophylactic cranial irradiation (PCI) as a component of their
therapy. Of the 10 patients who received PCI, none had brain recurrence,
while 36.4% of the non-PCI group developed brain metastases. Patients
receiving PCI demonstrated a trend toward improved PFS compared to
patients not receiving PCI (18.3 months versus 10.5 months, p=0.057). This
trend was also seen in OS in this group (25.4 months versus 15.5 months,
p=0.072). The median time from date of diagnosis to start of chemotherapy
was 21 days, and there was correlation between time to chemotherapy and
OS (p=0.037) and PFS (p=0.045). Twenty-six of the 32 patients underwent a
combination of chemotherapy and radiotherapy. Seventeen patients (65%)
received concurrent chemoradiotherapy, and 9 (35%) received sequential
chemoradiotherapy, with no significant difference in survival or toxicity
between these two regimens. Conclusion: Survival outcomes from this
single institution are comparable with current literature. The use of PCI in
appropriate patients can prevent cerebral metastases, improve PFS and
ultimately OS. The time to initiation of chemotherapy may also have a
significant impact on outcomes.
Keywords: limited stage, small cell lung cancer, cancer treatment, Survival
outcomes
POSTER SESSION 1 - P1.07: SCLC/NEUROENDOCRINE TUMORS
SCLC/NEUROENDOCRINE TUMORS IN GENERAL –
MONDAY, DECEMBER 5, 2016
P1.07-050 PATTERNS OF RELAPSE IN SMALL CELL LUNG CANCER
(SCLC): A RETROSPECTIVE ANALYSIS OF OUTCOMES FROM A
SINGLE CANADIAN CENTER
Abdulaziz Al Farsi 1 , Anand Swaminath 2 , Peter Ellis 2
1 Medical Oncology, Juravinski Cancer Center, Hamilton/Canada, 2 Oncology,
McMaster University, Hamilton/Canada
Background: We conducted a retrospective review of small cell lung cancer
patients (SCLC) to explore patterns of relapse and utility of Prophylactic
Cranial Irradiation (PCI). Methods: A retrospective chart review was carried
on patients diagnosed with SCLC from January 1 st 2011 until December 31 st
2014 and treated at Juravinski Cancer Center. The primary outcome was to
determine pattern of first relapse. Secondary outcomes were physician
assessed response rate, overall survival (OS), utilization of PCI, time to
systemic relapse (TTR) and time to central nervous system (CNS) relapse.
Results: A total of 275 patients were identified, of whom 46 (16.7%) received
no chemotherapy (median OS 2.2 months (m)) and were not included in
further analyses. The median age of 229 treated patients was 66 (SD 9.3)
yrs. There were 115 men, 114 women, 84 (37%) had limited stage (LS) and 145
(63%) extensive stage (ES) disease, performance status (PS) was 0-1 in 133
(58%), PS2 in 66 (28%) and PS3-4 in 32 (13%). Brain metastases were present
in 36 (16%) patients at diagnosis. Almost all patients received cisplatin (53%)
or carboplatin (43%) plus etoposide chemotherapy. Most patients received
4 (23%), or more (52%) cycles of chemotherapy. Physician assessed RR was
68% (PR 61%, CR 7%) and 16% of patients progressed during first-line therapy.
Thoracic radiation (TRT) was given to 112 (49%) of patients (LS 87%, ES 27%).
Patients with brain metastases at diagnosis, or progressing during firstline
chemotherapy were not considered eligible for PCI. Among 156 eligible
patients, 80 (51%) received PCI (LS 64%, ES 39%). Forty-one patients (26.3%)
declined PCI. The median overall survival for all patients was 11.1m (LS 21.7m,
ES 8.9m). Relapse occurred in 167 (73%) of patients: CNS alone 8.7%, CNS
plus systemic relapse (13.1%), thoracic (28%), extra-thoracic (9%), thoracic/
extra-thoracic (14%). Median time to any relapse was 9.2m (LS 14.3m, ES 7.5m),
while median time to CNS relapse was 6.9m (PCI given 6.2m, PCI not given
4.4m). Among 50 patients with CNS relapse, 16 received PCI (LS 9, ES 7) and
34 did not (LS 8, ES 26). Among 64 patients with thoracic relapse, 31 received
TRT (LS 19, ES 12) and 33 did not (LS 5, ES 28). Conclusion: Only 50% of eligible
SCLC patients receive PCI. CNS relapse occurs frequently and more commonly
in patients who do not receive PCI. Implementation of PCI in routine clinical
practice appears to influence patterns of recurrence.
Keywords: relapse, Patterns, SCLC
POSTER SESSION 1 - P1.07: SCLC/NEUROENDOCRINE TUMORS
SCLC/NEUROENDOCRINE TUMORS IN GENERAL –
MONDAY, DECEMBER 5, 2016
P1.07-051 INCIDENCE AND CLINICAL CHARACTERISTICS OF
PULMONARY LARGE-CELL NEUROENDOCRINE CARCINOMA: AN
OVERVIEW OF OUR OWN DATA
Gordana Drpa, Kaltrina Krasnic, Marina Serdarevic, Filip Popovic, Bernard
Budimir, Suzana Kukulj
Department of Mediastinal Tumours, Clinic for Respiratory Diseases “jordanovac”,
University Hospital Centre Zagreb, Zagreb/Croatia
Background: Pulmonary neuroendocrine tumors are a heterogenous group of
neoplasms. They are clasified into four histological types: typical carcinoid,
atypical carcinoid, small-cell lung cancer (SCLC) and large-cell neuroendocrine
carcinoma (LCNEC). They represent about 20% of all lung cancers. The most
frequent one is small-cell lung cancer with incidence about 15%. In contrast,
large-cell neuroendocrine carcinoma is an orphan disease with estimated
incidence between 2.1% and 3.5%. Because of many diagnostic difficulties,
LCNEC is considered to be of a higher frequency. It is lung neuroendocrine
tumor, but it is also a type of non small-cell lung cancer (NSCLC). So its
features overlap with both of these groups. However, the clinical behavior
of LCNEC is very similar to SCLC and so new term high-grade neuroendocrine
carcinoma (HGNEC) is in use. Methods: We retrospectively analysed
S376 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017