54P - Up front chemotherapy dosing and relative dose intensity in extensive stage small cell lung cancer

Date 07 May 2017
Event ELCC 2017
Session Poster Display Session
Topics Small-Cell Lung Cancer
Lung and other Thoracic Tumours
Presenter Anders Mølby
Citation Annals of Oncology (2017) 28 (suppl_2): ii17-ii20. 10.1093/annonc/mdx088
Authors A.W. Mølby1, B.E. Laursen2, U. Falkmer1, T. McCulloch1, N.A. Jensen1, L.Ø. Poulsen1
  • 1Department Of Oncology, Aalborg University Hospital, 9000 - Aalborg/DK
  • 2Institute Of Biomedicine, Aarhus University, 8000 - Aarhus C/DK

Abstract

Background

Extensive-stage small cell lung cancer (ES-SCLC) is an extremely aggressive malignant disease where patients often present with a poor performance status (PS), high age and several comorbidities. Reduced dose up front is a possibility for these patients. We investigated the impact of reduced dose up front and the impact of Relative dose intensity (RDI), age and comorbidity on overall survival (OS).

Methods

Data of a real-time registration study of a consecutive cohort, of patients treated with carboplatin and etoposide for ES-SCLC during 2012 and 2013 in the North Denmark Region, were analyzed. Patients only treated with one cycle of chemotherapy were excluded. Comorbidity was assessed according to the Charlson Comorbidity Index (CCI). Area Under the Curve (AUC), for carboplatin dose, was used for analysis of RDI. All dose reductions were made simultaneously in both carboplatin and etoposide. Multivariate statistical survival analysis was made using Cox Regression analysis calculating a Hazard Ratio (HR) for OS.

Results

In all, data from 75 patients were analyzed; mean age was 68 years; 44/75 (59%) were in PS 0-1 and 37/75 (49%) had 1 or more comorbidities. Reduced dose at baseline was applied to 25/75 (33%) of the patients. These patients had a HR 1.82, p-value = 0.070. RDI of 85% or below, was applied to 42/75 (56%) and showed a HR of 0.66, p-value = 0.228. Compared to PS 0-1, PS 2 showed a HR of 2.35 (p = 0.014) and PS 3-4 a HR of 8.40 (p < 0.000). Age, CCI, polypharmacy and LDH ≥ 300 U/L showed no statistical significant impact on OS. Hematological toxicity was the main reason for dose reductions and delays during chemotherapy, which occurred 19/75 (25%) and 47/75 (63%), respectively. Five patients died due to febrile neutropenia/sepsis. Fourteen long-term survivors were seen with an OS of more than 20 months.

Conclusions

These results suggest that full dose chemotherapy should be applied up front, though poor PS is a major limiting factor, whereas high age should not be. RDI showed no impact on OS, but larger studies are needed. Data concerning fourteen long-term survivors will be presented at the meeting.

Clinical trial identification

Legal entity responsible for the study

Aalborg University Hospital, Department of Oncology

Funding

N/A

Disclosure

All authors have declared no conflicts of interest.