Best Of Best Poster Oral Clinical Oncology Society of Australia Annual Scientific Meeting 2017

Application of clinical guidelines in the management of small cell lung cancer (#138)

Kate Wilkinson 1 , Mei Ling L Yap 2 , Alison E Freimund 3 , Joseph Descallar 4 , Thompson Ly 5 , Victoria Bray 6 , Po Yee Yip 7
  1. Dept Medical Oncology, Bankstown Cancer Centre, Bankstown, Sydney, NSW, Australia
  2. Dept Radiation Oncology , Liverpool Cancer Therapy Centre, Liverpool, Sydney , NSW, Australia
  3. Dept Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown, Sydney, NSW, Australia
  4. Ingham Institute for Applied Medical Research, Liverpool, Sydney, NSW, Australia
  5. School of Medicine , Western Sydney University , Sydney, NSW, Australia
  6. Dept Medical Oncology, Liverpool Cancer Therapy Centre, Liverpool, Sydney, NSW, Australia
  7. Dept Medical Oncology, Macarthur Cancer Therapy Centre , Campbelltown, Sydney, NSW, Australia

Aims:

International consensus guidelines recommend concurrent chemo-radiotherapy +/- prophylactic cranial irradiation (PCI) for patients with limited-stage small cell lung cancer (LS SCLC), and palliative chemotherapy +/- PCI for patients with extensive-stage disease (ES SCLC). The feasibility and application of guideline recommended treatment in the real world population is unknown. The primary aims were: (i) determine the proportion of patients receiving clinical guideline (CG) vs. modified (M) treatment; and (ii) compare survival outcomes between groups.

Methods:

A retrospective review of prospectively collated data for patients treated in South Western Sydney between 2006 and 2014 was performed. Baseline clinico-pathological data, treatment modalities and outcome data were captured. The proportion of patients receiving CG vs. M treatment was recorded. The two groups were compared with regards to overall survival (OS) using the Kaplan-Meier method. Multivariate analysis was performed to identify potential confounders.

Results:

256 patients were identified: 102 with LS SCLC; 154 with ES SCLC. Mean age was 68 years. In the LS SCLC cohort, 34% of patients received CG treatment. Presentation at a multi-disciplinary team meeting was high (83%).  Median OS for CG vs. M treatment was 25 months vs. 13 months (HR 1.95, p= 0.009). Main reasons for M treatment were poor baseline ECOG performance status (PS), co-morbidities and patient choice. On multivariate analysis, poor ECOG PS and higher Charlston Comorbidity Index score were independent predictors for worse OS. For the ES SCLC cohort, 64% of patients received CG treatment. The median OS for CG vs. M treatment was 7.5 months vs. 3 months (HR 1.62, p = 0.004).

Conclusions:

It is challenging to deliver guideline recommended treatment in routine clinical practice. The key barriers to this are patient co-morbidities and ECOG PS. Future advances in systemic therapy and radiation techniques may make treatment more tolerable and deliverable in this group.