Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
61 Gy negatively impacted OS.
Keywords: consolidation chemotherapy, Locally advanced NSCLC, overall
survival, Concurrent Chemoradiation
POSTER SESSION 2 – P2.02: LOCALLY ADVANCED NSCLC
MULTIMODALITY TREATMENT –
TUESDAY, DECEMBER 6, 2016
P2.02-031 SURVIVAL DATA OF POSTOPERATIVE ADJUVANT
CHEMOTHERAPY OF CISPLATIN PLUS VINORELBINE FOR
COMPLETELY RESECTED NSCLC: A RETROSPECTIVE STUDY
Hirotsugu Kenmotsu 1 , Yasuhisa Ohde 2 , Akira Ono 1 , Kazuhisa Nakashima 1 ,
Shota Omori 1 , Kazushige Wakuda 1 , Tateaki Naito 1 , Haruyasu Murakami 1 ,
Hideaki Kojima 3 , Shoji Takahashi 3 , Mitsuhiro Isaka 3 , Masahiro Endo 4 , Toshiaki
Takahashi 1
1 Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka/Japan, 2 Thoracic
Surgery, Shizuoka Cancer Center, Shizuoka/Japan, 3 Division of Thoracic Surgery,
Shizuoka Cancer Center, Shizuoka/Japan, 4 Division of Diagnostic Radiology,
Shizuoka Cancer Center, Shizuoka/Japan
Background: Although the efficacy of postoperative adjuvant cisplatin (CDDP)-
based chemotherapy, such as the combination of CDDP and vinorelbine
(VNR) has been established for surgically resected non-small cell lung cancer
(NSCLC), there has been some reports about the survival data of Asian patients
treated with the combination of CDDP and VNR as adjuvant chemotherapy.
Methods: We retrospectively have evaluated patient compliance and the
safety of adjuvant chemotherapy with CDDP at 80 mg/m 2 administered on
day 1 plus VNR at 25 mg/m 2 administered on days 1 and 8, every 3 weeks at the
Shizuoka Cancer Center between February 2006 and October 2011 (Kenmotsu,
et al. Respir Investig 2012). In this study, we evaluated survival data of these
patients. Overall survival (OS) and relapse-free survival (RFS) after the start
of adjuvant chemotherapy conducted by the Kaplan-Meier method to assess
the time to death or relapse. Results: One hundred surgically resected NSCLC
patients were included in this study. The characteristics of the patients were as
follows: median age 63 years (range: 36–74); female 34%; never smokers 20 %;
histology non-squamous/ squamous cell carcinoma 73%/ 27%; EGFR mutation
mutant/ wild/ unknown 19%/23%/58%. Pathological stages IIA/IIB/IIIA were
observed in 31/22/47%. The median time from surgical resection to the start
of adjuvant chemotherapy was 44 days (range: 29–79 days). Median follow up
was 5.6 years (range, 3.8 – 9.7 years). The five-year OS rate was 73% and the
2-year OS rate was 93%. The five-year RFS rate was 53% and the 2-year RFS
rate was 62%. A univariate analysis of prognostic factors showed that patient
characteristics (gender, histology, pathological stage) and dose intensity of
cisplatin were not significantly associated with OS. Conclusion: Our results
suggested that the prognosis of surgically resected NSCLC patients, who were
treated with the combination of CDDP and VNR as adjuvant chemotherapy,
might be better than previous results of adjuvant chemotherapies for NSCLC
patients. This result can be influenced by the advances of diagnostic and
surgical procedures, and the efficacy of chemotherapy including molecular
target therapies.
Keywords: Cisplatin, non-small cell lung cancer, adjuvant chemotherapy,
survival
POSTER SESSION 2 – P2.02: LOCALLY ADVANCED NSCLC
MULTIMODALITY TREATMENT –
TUESDAY, DECEMBER 6, 2016
P2.02-032 INDUCTION HISTOLOGY-BASED COMBINATION
CHEMOTHERAPY FOR ELDERLY PATIENTS WITH INOPERABLE NON-
SMALL CELL LUNG CANCER (NSCLC)
Giuseppe Banna 1 , Giuseppe Anile 2 , Marine Castaing 3 , Ezio Urso 1 , Maurizio
Nicolosi 4 , Salvatore Strano 5 , Francesco Marletta 6 , Stefania Calì 1 , Rohit Lal 7
1 Division of Medical Oncology, Cannizzaro Hospital, Catania/Italy, 2 Division
of Medical Oncology, Istituto Oncologico Veneto, Padova/Italy, 3 G.F. Ingrassia
Department, University of Catania, Catania/Italy, 4 Division of Thoracic Surgery,
Cannizzaro Hospital, Catania/Italy, 5 4Division of Thoracic Surgery, Cannizzaro
Hospital, Catania/Italy, 6 Division of Radiotherapy, Cannizzaro Hospital, Catania/
Italy, 7 Lung Cancer Unit, Guy’s and St Thomas’ Hospital, London/United Kingdom
Background: SABR is an acceptable treatment of elderly patients with
inoperable stage I-II NSCLC; for the stage III, sequential chemoradiotherapy
may be appropriate, since it is better tolerated than concurrent
chemoradiotherapy. Methods: In a prospective phase II not randomised
study, patients aged 70 years or more with inoperable stage IIIA and IIIB
histologically confirmed squamous cell carcinoma (SCC) or adenocarcinoma
NSCLC and ECOG performance status (PS) 0-2, were treated with 3 cycles of
induction chemotherapy according to their histology followed by definitive
radiotherapy or possibile surgery in selected cases. Chemotherapy regimens
included: carboplatin at AUC 5 i.v. plus gemcitabine 1000 mg/mq i.v. on days
1,8 or pemetrexed 500 mg/mq i.v. every 21 days in patients with squamous
or adenocarcinoma, respectively. Primary endpoint was activity as defined
by the overall response rates (ORR) following induction chemotherapy and
overall survival (OS); secondary endpoints included feasibility outcome
(i.e., toxicity, rate of definitive radioterapy, chemotherapy dose reduction
or withdrawal) and progression-free survival (PFS). Results: Twenty-seven
patients, 23 males, 4 females, with a median age of 74 years (range, 70-80),
PS=0/1 in 9/15 (33/56%) or 2 in 3 (11%) and median of 2 (range, 0-5) active
comorbidities requiring medical treatment were treated. Fourteen patients
(52%) had an adenocarcinoma and were treated with carboplatin and
pemetrexed, 13 a SCC (42%) with carboplatin and gemcitabine. Eight patients
(30%) had a stage IIIA, 19 patients (70%) a stage IIIB. The median cycle of
chemotherapy was 3 (range, 1-4). Dose reduction or withdrawal was required
in 2 and 3 patients, respectively (18%). ORR was 46% (in 12 of 26 assessable
patients); 5 patients with a SCC (42%) and 7 patients with an adenocarcinoma
(50%). SD and PD were reported in 4 (15%) and 10 (38%) patients, respectively.
Twelve patients (44%) were subsequently treated with radiotherapy, 8 (42%)
with stage IIIB and 4 (50%) with stage IIIA. Two patients (7%) with stage IIIA
disease underwent lobectomy. With a median follow-up of 10.2 months, 9
patients (33%) were alive and progression-free; median OS and PFS data
will be shown. G1-G2 neutropenia, asthenia, anemia, nausea/vomiting and
diarrhoea were the most frequent toxicity observed in ³ 10% of patients and
up to 45% for neutropenia. G3-4 neutropenia, asthenia, thrombocytopenia
and fever was reported in one patient each (4%), G3 anemia in 2 patients.
Conclusion: In a broad elderly NSCLC population induction histology-based
chemotherapy seems to be active and feasible in selected patients.
Keywords: locally advanced, induction chemotherapy, elderly, NSCLC
POSTER SESSION 2 – P2.02: LOCALLY ADVANCED NSCLC
MULTIMODALITY TREATMENT –
TUESDAY, DECEMBER 6, 2016
P2.02-033 THE ROLE OF SURGERY FOR TREATING OCCULT N2 NON-
SMALL CELL LUNG CANCER
Masashi Yanada 1 , Yoshiaki Matsuura 1 , Masayoshi Inoue 2
1 General Thoracic Surgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto/Japan,
2 Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University
of Medicine, Kyoto-City/Japan
Background: The presence of mediastinal nodal metastasis is one of the most
important factors in the treatment of non-small cell lung cancer (NSCLC). The
role of surgical intervention for treating N2 disease is controversial, and two
randomized trials failed to show an overall survival benefit. Consequently,
the purpose here is to elucidate the needs for surgical intervention of
resectable N2 NSCLC. Methods: Between April 2010 and May 2016, 316
patients with NSCLC underwent pulmonary resection and mediastinal lymph
node dissection. Patients with pathologic N2 were 26. Clinical outcomes
and risk factors for pathologic N2 disease were retrospectively analyzed for
this cohort. Results: Surgical treatment was performed of 26 pathologic
N2 disease patients; there were 18 men and 8 women with a mean age of
68.3 years old (range 55-84). Occult pathologic N2 disease was identified
in 22 patients (84.6%). The most common type of resection was lobectomy
(96.1%). Adjuvant chemotherapy was administered in 21 patients (80.8%).
N2 involvement was single-station in 4 (15.4%) and multiple-station in 22
(84.6%). All patients recovered and were discharged home. There was no
operative mortality, and no hospital deaths. The 5-year overall and diseasefree
survival rates were 58.6% and 33.4%, respectively. The 5-year survival
rates of single-station and multiple-station N2 were 50% and 73.2%,
respectively (p =0.92). Patients with clinical (expected) N2 disease exhibited
better survival outcomes compared with those with occult N2 disease (100%
vs 59.8%). The group receiving adjuvant chemotherapy had significantly
higher the 5-year survival rates. The 5-year survival rate in patients who
received 4 or more cycles of adjuvant chemotherapy was 78.1%, as compared
with 0% in non-treated patients (p =0.0008). Conclusion: The 5-year overall
and disease-free survival rates of N2 disease tend to improve in recent years.
The reasons for improved survival are the increasingly successful treatment
options for recurrent disease, including chemotherapy, radiotherapy, and/
or molecular targeting drugs. It is common knowledge that therapy of N2
disease needs not only surgery but also chemotherapy. The multiple courses
of adjuvant chemotherapy may further improve the outcome in N2 disease.
However, patients treated with surgery and chemotherapy had significantly
better the 5-year survival rates than patients treated with chemotherapy
alone. Though surgery might be very important in that way, the role of surgery
for treating N2 disease remains an open question. Because we acknowledge
that as a single-institution and retrospective analysis, our sample size was
limited. We consider that large-scale, multicenter clinical trials are needed.
Keywords: mediastinal metastases, lung cancer, Lymphadenectomy
Copyright © 2016 by the International Association for the Study of Lung Cancer
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