- A. Dingemans (Rotterdam, Netherlands)
- M. Pérol (Lyon, CEDEX, France)
43O - Trends of Incidence and Burden of Metastatic Disease at the Time of Diagnoses of Lung Cancer after Implementation of Low Dose CT Screening in United States
- P. Bedi (Pittsburgh, PA, United States of America)
- P. Bedi (Pittsburgh, PA, United States of America)
- M. Rai (Pittsburgh, PA, United States of America)
- S. Siddappa Malleshappa (Pittsburgh, PA, United States of America)
- P. Neupane (Kansas City, KS, United States of America)
- C. Huang (Kansas City, KS, United States of America)
- J. Zhang (Kansas City, KS, United States of America)
- K. Mehta (Pittsburgh, United States of America)
Abstract
Background
The incidence of lung cancer has been declining in the United States (US) from 2007 to 2014. However, the impact of implementation of low dose CT screening (LDCT) in high risk population in 2015, on incidence of lung cancer and on proportion of patients with metastatic disease at the time of diagnosis in that population is unknown.
Methods
We conducted a cross-sectional study using Surveillance, Epidemiology, and End Results data to identify trends of incidence of lung cancer and proportion of patients with metastatic disease at the time of diagnoses across 4 periods from 2007 to 2016. Period 1 and period 2 occurred before publication of National Lung Cancer Screening Trial (NLST) to establish baseline trends (2007-2009 and 2010- 2011 respectively). Period 3 and period 4 were after publication of NLST (2012-2014) and LDCT implementation (2015-2016) respectively. The population of interest was between the age of 55-79 years.
Results
The study included 471,300 patients with newly diagnosed lung cancer with age of 55-79 years (mean age 68.2 [6.7] years, 52.5% male, 83.3% white, 11.1% black and 5.4% Hispanic). The age adjusted incidence of lung cancer steadily declined from 243.9 per 100,000 population in period 1 to 203.2 per 100,000 population in period 4. The proportion of patients with metastatic disease at the time of diagnoses was stable before publication of NLST (0.04% increase from period 1 to period 2, p=0.8) and remained stable after publication of NLST until implementation of LDCT (0.28% decrease from period 2 to period 3, p=0.2). Compared with this baseline trend, implementation of LDCT was significantly associated with a decrease in proportion of patients with metastatic disease at the time of diagnoses (3.29% decrease from period 3 to period 4: difference in change, -3.33%, P < 0.01). These results were consistent in sex (male or female), race (white, black or other) and ethnic (Hispanic or non-Hispanic) subgroups.
Conclusions
After implementation of LDCT screening, proportion of lung cancer patients with metastatic disease at the time of diagnoses have declined in US without any impact on trends of incidence of lung cancer among population with age of 55-79 years.
Invited Discussant 43O
- M. Pérol (Lyon, CEDEX, France)
- M. Pérol (Lyon, CEDEX, France)
One LBA TBC
224O - First-Line Tyrosine Kinase Inhibitor With or Without Aggressive Upfront Local Radiation Therapy In Patients With EGFRm Oligometastatic Non-Small-Cell Lung Cancer: Interim Results of A RandomizedPhase III, Open-Label ClinicalTrial (SINDAS) (NCT02893332).
- M. Wu (Chengdu, China)
- M. Wu (Chengdu, China)
- M. Zhou (Chengdu, China)
- X. Luo (Chengdu, China)
- Y. Bai (Chengdu, China)
- X. Wang (Chengdu, China)
- M. Zeng (Chengdu, China)
Abstract
Background
The effectiveness of aggressive local therapy for oligometastatic non-small-cell lung cancer (NSCLC) is unknown. This multi-institutional, randomized, open label, phase IIIclinical trial was performed to assess upfront stereotactic radiotherapy to all sites of diagnoses in previously untreated EGFRm oligometastatic non-small-cell lung cancer on progression-free survival and overall survival.The effectiveness of aggressive local therapy for oligometastatic non-small-cell lung cancer (NSCLC) is unknown. This multi-institutional, randomized, open label, phase III clinical trial was performed to assess upfront stereotactic radiotherapy to all sites of diagnoses in previously untreated EGFRm oligometastatic non-small-cell lung cancer on progression-free survival and overall survival.
Methods
Eligible participants had pathologically confirmed adenocarcinoma, gene sequencing confirmed EGFRm, stage IV, five or fewer metastatic disease lesions, an ECOG score of ≤ 2, systemic therapy naive, and no brain disease before randomization. Participants were randomized to receive either first-line tyrosine kinase inhibitor (TKI) treatment alone or upfront stereotactic radiotherapy to all sites of disease along with TKI treatment.
Results
Between 1/ 2016 to 1/2019, 133 participants were enrolled, including 65 in the TKI arm and 68 in the stereotactic radiotherapy and TKI. The median progression-free survival for tyrosine kinase inhibitor alone was 12.5 months, and for tyrosine kinase inhibitor and stereotactic radiotherapy was 20.20months, respectively (HR 0.6188 [95% CI 0.3949-0.9697], log rank P< .001). The median overall survival in the TKI alone arm was 17.40 months, and for TKI and stereotactic radiotherapy arm was 25.50 months, respectively (HR 0.6824 [95% CI 0. 4654-1.001], log rank P< .001).
Conclusions
Upfront stereotactic radiotherapy to sites of diagnosis along with first line TKI improved both progression-free survival and overall survival significantly compared to the TKI alone.
Invited Discussant One LBA TBC and 224O
- R. Dziadziuszko (Gdansk, Poland)
- R. Dziadziuszko (Gdansk, Poland)