Abstract 4319
Background
Concurrent chemo-radiotherapy (cCRT) is the preferred treatment for most stage III NSCLC, with 5 year survival of 25-35%. Recent dose-escalated radiotherapy (RT) trials report a high incidence of cardiac events (CTCAE ≥ 3 of 11 – 23%) in NSCLC. However, real world data on the incidence of cardiac events are lacking.
Methods
In this multicenter retrospective cohort study a thorough patient file search was carried out in all consecutive pts treated with (C)RT for stage III NSCLC between 2006 - 2013. The primary endpoint of this study was incidence of new cardiac event (CTCAE ≥ 2) within five years after (C)RT. Secondary we evaluated risk factors for cardiac events.
Results
474 pts with stage III NSCLC were eligible. 391 were treated with cCRT, 69 with sequential CRT, 8 with lobectomy and/or RT and 6 are unknown. 30% of the pts had a cardiac history; mostly consisting of coronary artery disease (13.1%), atrial arrhythmia (7.4%) and chronic heart failure (4.2%). In 5 years of follow-up 151 pts (31.9%) developed a new cardiac events with a median time to event of 8 months (range 0 - 59). The most common cardiac events were arrhythmia (14.6%), heart failure (7.6%) and symptomatic coronary artery disease (6.8%). On multivariate analysis pre-existent cardiac comorbidity (hazard ratio [HR] 1.72; 95% CI 1.07 – 2.78; P = 0.02), WHO-PS ≥ 2 (HR 1.72; 95% CI 1.07 – 2.78; P = 0.03), male gender (HR 1.43; 95% CI 1.01 – 2.02; P = 0.04) and age ≥ 70 (HR 1.42; 95% CI 1.018 – 1.98; P = 0.03) were significantly associated with a cardiac event. Within the subgroup of pts without pre-existent cardiac comorbidity (N = 311), 27.1% developed a cardiac event and only age ≥ 70 was a significant predictor (HR 1.78; 95% CI 1.15 – 2.75; P = 0.01).
Conclusions
Approximately one third of stage III NSCLC pts treated in daily clinical practice develop a new cardiac event within 5 years after (C)RT. Pre-existent cardiac comorbidity, WHO-PS ≥ 2, age ≥ 70 and male gender are absolute risk factors for the development of a cardiac event. Because cardiac events cause a high burden of morbidity and can influence quality of life, screening for cardiac comorbidity and events, especially in the first year after treatment should be considered.
Clinical trial identification
Legal entity responsible for the study
Maastricht University Medical Center (MUMC+).
Funding
Has not received any funding.
Editorial Acknowledgement
Disclosure
A-M.C. Dingemans: Other from Roche/Genentech, MSD Oncology, AstraZeneca, Pfizer, Lilly, other from Boehringer Ingelheim, Bristol-Myers Squibb, Clovis Oncology, outside the submitted work. All other authors have declared no conflicts of interest.