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Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research

1162 - A pooled analysis of individual patient data (IPD) of concurrent chemoradiotherapy for limited-stage small cell lung cancer (LS-SCLC) in elderly compared to younger patients (pts) who in participated US National Cancer Institute Cooperative Group studies

Date

20 Oct 2018

Session

Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research

Topics

Cytotoxic Therapy

Tumour Site

Presenters

Thomas Stinchcombe

Citation

Annals of Oncology (2018) 29 (suppl_8): viii596-viii602. 10.1093/annonc/mdy298

Authors

T.E. Stinchcombe1, W. Fan2, S.E. Schild3, E.E. Vokes4, J. Bogart5, Q.X. Le6, C.R. Thomas, Jr.7, M. Edelman8, L. Horn9, R. Komaki10, H.J. Cohen1, A.K. Ganti11, H. Pang12, X. Wang13

Author affiliations

  • 1 Medical Oncology, Duke Cancer Center, 27710 - Durham/US
  • 2 Biostatistics And Bioinformatics, Duke University, 27710 - Durham/US
  • 3 Radiation oncology, Mayo Clinic Arizona, 86255 - Scottsdale/US
  • 4 Medical Oncology, The University of Chicago Medical Centre, 60637-1470 - Chicago/US
  • 5 Radiation oncology, SUNY Upstate Medical University, 13210 - Syracuse/US
  • 6 Department Of Radiation oncology, Stanford University School of Medicine, 94305 - Stanford/US
  • 7 Department Of Radiation Medicine, Oregon Health & Science University, Portland/US
  • 8 Medical Oncology, Fox Chase Cancer Center, 19111-2497 - Philadelphia/US
  • 9 Medical Oncology, Vanderbilt Ingram Cancer Center, 37232-6307 - Nashville/US
  • 10 Radiation oncology, MD Anderson Cancer Center, 77030-4095 - Houston/US
  • 11 Medical Oncology, University of Nebraska Medical Center, Omaha/US
  • 12 School Of Public Health, Hong Kong University Li Ka Shing Faculty of Medicine, Hong Kong/CN
  • 13 Biostatistics, Alliance Statistics and Data Center, Durham/US
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Resources

Abstract 1162

Background

Platinum and etoposide with concurrent thoracic radiation is the standard treatment for LS-SCLC. Elderly pts are common, and may experience higher rates of adverse events (AEs) and have a worse outcome from this treatment.

Methods

IPD were collected from 11 phase 2 or 3 trials for LS-SCLC conducted by the US National Cancer Institute-supported cooperative groups activated from 1990 to 2010. Overall survival (OS), progression-free survival (PFS) and AEs were compared between pts age ≥ 70 years (elderly) and for pts < 70 years (younger). Unadjusted and adjusted hazard ratios (HRs) for survival time and CIs were estimated by univariate and multivariable frailty Cox models.

Results

IPD from 1049 younger and 254 elderly pts were analyzed. In the univariate and multivariable models, elderly pts compared with younger pts had worse OS (HR of 1.40; 95% CI, 1.20 to 1.65 and 1.36; 95% CI, 1.15 to 1.59). Median OS in elderly and younger pts was 17.8 months and 23.5 months, respectively. In the univariate and multivariable models, elderly pts had worse PFS (HR of 1.23; 95% CI, 1.06 to 1.43 and 1.19; 95% CI, 1.03 to 1.39). Median PFS in elderly and younger pts was 10.6 and 12.3 months, respectively. Elderly and younger pts had a similar rates of all grade ≥ 3 AEs, but elderly pts had a statistically significantly higher rate of all grade ≥ 4 AEs (p < 0.01), hematologic ≥ 4 AEs (p < 0.01), and grade 5 AEs (8% vs 3%, p < 0.001). When specific AEs were analyzed, elderly pts experienced a higher rate of grade ≥ 3 dyspnea (p = 0.03), but a lower rate of grade ≥ 3 vomiting (p = 0.01) and esophagitis (p = 0.03). Elderly pts compared with younger pts completed treatment at a lower rate (p = 0.02), stopped treatment at higher rates due to adverse events (p = 0.02), patient refusal (p < 0.01), and death during treatment (p < 0.01).

Conclusions

Elderly pts with LS-SCLC experienced a worse PFS and OS, and experienced a statistically higher rate of grade 4 and 5 adverse events. Future trials should investigate methods to identify vulnerable elderly pts and reduce the toxicity of treatment.

Clinical trial identification

Legal entity responsible for the study

Tom Stinchcombe and Xiaofei Wang.

Funding

NIH grant: R21-AG042894.

Editorial Acknowledgement

Disclosure

All authors have declared no conflicts of interest.

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