Annual Meeting Proceedings Part 1 - American Society of Clinical ...

456s Lung Cancer—Non-small Cell Local-Regional/Small Cell/Other Thoracic Cancers
7018 Poster Discussion Session (Board #10), Sun, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
SWOG S0533: A pilot trial of cisplatin (C)/etoposide (E)/radiotherapy (RT)
followed by consolidation docetaxel (D) and bevacizumab (B) (NSC-
704865) in three cohorts of patients (pts) with inoperable locally advanced
stage III non-small cell lung cancer (NSCLC). Presenting Author: Antoinette
J. Wozniak, Karmanos Cancer Institute, Wayne State University,
Detroit, MI
Background: Bevacizumab combined with chemotherapy has improved
survival in the treatment of advanced NSCLC. This pilot trial was conducted
to determine if bevacizumab could be incorporated into the standard
chemotherapy/RT for locally advanced NSCLC. Methods: Pts with unresectable
stage III NSCLC, PS 0-1, and adequate organ function were eligible.
Pts were accrued in two strata, low and high risk (squamous histology,
hemoptysis, tumor with cavitation or near a major vessel). Pts were treated
with C 50mg/m2 (d 1 and 8), E 50mg/m2 (d 1-5) for 2 cycles concurrent
with RT (64.8 Gy at 1.8 Gy/fx for 36 fxs) followed by consolidation D
75mg/m 2
and B 15 mg/kg for 3 cycles (Cohort 1). If safety was established
then accrual would continue to Cohort 2 (B, d 15, 36, 57) and then Cohort
3 (B d 1, 22, 43). Results: 29 pts (17 Low, 12 High) were registered, all to
Cohort 1. 26 pts (stage IIIB 19 pts, squamous 4 pt, adenosquamous 1 pt)
were evaluable. 25 completed chemo/RT. Grade 3/4 toxicities during
chemo/RT included: neutropenia 10 pts, thrombocytopenia 2, anemia 2,
febrile neutropenia 3, esophagitis 2, pneumonitis 1. 21 were assessed for
safety with D/B consolidation. The major adverse events during D/B
consolidation were pneumonitis (Gr 3-2pt)and2episodes of fatal
hemoptysis in the high risk group resulting in closure of this stratum. The
low risk stratum subsequently closed because of poor accrual. Median
overall survival was 23 mos for low risk pts and 17 mos for the high risk
stratum. Conclusions: In this trial, bevacizumab could not be successfully
integrated into chemo-radiation for stage III NSCLC, particularly in pts
considered at high risk for hemoptysis. The trial suffered from several
temporary closures as mandated by CTEP when new bevacizumab-related
toxicities were reported, contributing to slow accrual. In lower risk pts the
data are insufficient to determine safety or efficacy. Supported in part by
the following PHS Cooperative Agreement grant numbers awarded by the
National Cancer Institute, DHHS: CA32102 and CA38926.
7020 Poster Discussion Session (Board #12), Sun, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Favorable outcomes with chemoradiation and surgery for locally advanced
non-small cell lung cancer: The BC Cancer Agency Vancouver experience.
Presenting Author: Wen Wen Shan, University of British Columbia, Vancouver,
BC, Canada
Background: The role of surgery following concurrent platinum-based
chemotherapy and radiation for locally advanced non-small cell lung
cancer (NSCLC) remains controversial, with high surgical mortality rates
reported in a large randomized clinical trial. In this retrospective study, we
evaluated the safety and efficacy of concurrent chemoradiation with or
without surgery over an 11 period at the BC Cancer Agency. Methods:
Patients were identified by the Vancouver Centre Pharmacy database.
Charts were reviewed and data extracted included patient characteristics,
weight loss, performance status, and method of mediastinal staging.
Outcome measures were overall survival, pathological response rate, and
treatment-associated morbidity and mortality. Results: Between January
1999-2010, 177 patients were identified with locally advanced NSCLC
(stage IIIA/B) treated with platinum and etoposide and �40Gy radiation
therapy, with or without surgical resection. The majority of treatment plans
were reached by a multidisciplinary conference consensus. 74% (n�131)
of patients received chemoradiation alone (bimodality therapy) and 36%
(n�46) received chemoradiation followed by surgical resection (trimodality
therapy). Among the trimodality therapy group, 16 patients underwent
pneumonectomy and 30 lobectomy. Conclusions: In this series, bimodality
therapy for patients with locally advanced NSCLC had similar treatment
associated mortality and survival outcomes as reported in the literature.
Trimodality therapy was associated with low treatment mortality rates and
favourable survival. These two groups cannot be directly compared in this
retrospective study. However, these results support a multidisciplinary
approach to identify and carefully select patients with locally advanced
NSCLC to undergo additional surgical resection following concurrent
chemoradiation.
Treatment-associated complications and survival.
Bimodality Trimodality
Complications
Hospitalization 24% 11%
Death on treatment 5% 2%
Survival
Median OS 19.6 mo 68 mo
5-year OS 17.5% 53.2%
7019 Poster Discussion Session (Board #11), Sun, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
A randomized, multicenter phase II study investigating additional weekly
cetuximab to concurrent chemoradiotherapy in locally advanced non-small cell
lung carcinoma: Reporting on the efficacy. Presenting Author: Michel M. van den
Heuvel, Medical Oncology Department, The Netherlands Cancer Institute/Antoni
van Leeuwenhoek Ziekenhuis, Amsterdam, Netherlands
Background: Modest benefits from concurrent chemoradiotherapy (CRT) in
patients with locally advanced NSCLC warrant more effective treatment regimen.
Cetuximab, a monoclonal antibody against the epidermal growth factor receptor
has shown activity in NSCLC. Feasibility data and toxicity have been published
previously. We report treatment outcome of a multicenter phase II study of the
combination of high dose accelerated RT and daily dose cisplatin with or without
weekly cetuximab. Methods: Patients with locally advanced NSCLC received
accelerated RT (66 Gy in 24 fractions) and concurrent daily cisplatin (6 mg/m2 )
with (Arm A) or without (Arm B) additional weekly cetuximab (400 mg/m2 loading dose one week prior to the RT start followed by weekly 250 mg/m2 ). The
Objective Local Response Control (OLRC) was determined at 6 and 24 weeks
after treatment using response evaluation criteria in solid tumours criteria.
Results: Between Feb 2009 and May 2011, 102 patients were included. Median
follow-up was 13 months. Patients and tumor characteristics are shows in the
Table. Stage distribution was: II (8%), IIIa (51%), and IIIb (40%). The CRT was
well tolerated. The OLRC at 24 weeks was 79% in Arm A and 80% in Arm B. The
one-year progression free survival and overall survival were 58% (45%-76%) and
76% (64%-91%) for Arm A and 49% (35%-68%) and 72% (58%-89%) for Arm
B respectively. Conclusions: The addition of cetuximab to low dose cisplation
CRT does not improve OLRC in an unselected patient cohort but data on
longterm disease control and survival are to be awaited.
Characteristics of patients treated with concurrent chemoradiotherapy.
CRT CRT � cetuximab
Age (years, range) 63 (37-78) 62 (29-80)
Female / Male 29% / 71% 33% / 67 %
Ethnic origin (Asian/non-Asian) 2%/98% 6%/94%
Staging:
4%
12%
-IIa/b
54%
47%
-IIIa
-IIIb
41%
41%
Histology:
32%
33%
-Adeno
28%
24%
-Large cell
38%
41%
-Squamous
-Other
2%
2%
Smoking history
3%/49%/49%
3%/37%/61%
(Never/former/current)
42%/56%/2%
39%/61%/0%
PS 0/1/2
FEV1 (%)
87% (39%-151%)
77% (40%-121%)
GTV (cm3 )
PTV (cm 3 )
107 (25-907)
547 (66-1766)
120 (5-460)
451 (49-1855)
SUVmax 13.7 (6.3-35.9) 10.9 (6.2-31.8)
7021 Poster Discussion Session (Board #13), Sun, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Comparison between diameters of the whole nodule and solid area and the
proportion of GGO in the tumor shadow on HRCT in predicting less-invasive
lung cancer and recurrence after complete resection in patients with
clinical N0 NSCLC. Presenting Author: Haruhisa Matsuguma, Division of
Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Japan
Background: Prediction of less-invasive lung cancer is important in selecting
candidates for limited surgical resection. A greater proportion of
ground-glass opacity (%GGO) is well-known to be strongly associated with
less-invasive lung adenocarcinoma. Recently, the diameter of the solid area
(SolidØ) has been reported to also be a simple and better marker for the
same purpose compared to the diameter of the whole nodule (NoduleØ).
The aim of this study was to confirm that SolidØ can completely replace
%GGO in predicting less-invasive lung cancer. Methods: From 1987 to
2009, 433 patients with clinical T1a-2bN0 NSCLC underwent complete
resection, and their preoperative HRCT images were preserved in DICOM
format. NoduleØ and SolidØ were precisely measured using software.
%GGO was calculated using the method we previously published (Eur J
Cardiothorac Surg 25:1102-6, 2004). Less-invasive lung cancer was
defined as having no vascular, lymphatic, nor pleural invasion. We
compared the three parameters with regard to predicting less-invasive lung
cancer and recurrence. Results: Among the 433 patients, 220 were male,
367 had an adenocarcinoma histology, and 58 experienced recurrence.
Table shows percentages and numbers of non-less-invasive lung cancer
cases. Among each category of SolidØ, greater %GGO is associated with
less-invasive lung cancer. ROC analysis also showed that the area under the
curve of %GGO was the highest (0.859, 95% CI 0.824 – 0.893), followed
by SolidØ (0.806, 0.767 – 0.846), and NoduleØ (0.671, 0.620 – 0.721).
Regardless of SolidØ, no patient with a greater %GGO (� 50%) experienced
recurrence. Conclusions: Although SolidØ is a better prognostic
indicator of non-invasiveness compared to NoduleØ, %GGO remains
important.
SolidØ %GGO 0-9% 10-49% 50-79% 80-100%
31mm~ 22/22 (100) 30/33 (91) 1/3 (33) 0/0 (0)
25~30mm 15/21 (71) 28/31 (90) 3/5 (60) 0/0 (0)
21~25mm 36/30 (87) 38/64 (59) 0/4 (0) 0/0 (0)
16~20mm 40/49 (82) 48/76 (63) 3/12 (25) 0/1 (0)
11~15mm 14/22 (64) 24/59 (41) 2/27 (7) 0/3 (0)
6~10mm 3/5 (60) 3/7 (43) 0/18 (0) 0/19 (0)
0~5mm 0/1 (0) 0/2 (0) 0/2 (0) 0/23 (0)
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