Daniel Yokom

Radical Treatment of Stage II Non–small-cell Lung Cancer With Nonsurgical Approaches: A Multi-institution Report of Outcomes

Introduction Standard management of stage II non–small‐cell lung cancer (NSCLC) is surgery, often followed by adjuvant chemotherapy. However, some patients do not undergo surgery for various reasons. We examined outcomes in this defined patient group. Methods We reviewed the records of patients with stage II NSCLC treated nonsurgically with curative intent from 2002 to 2012 across 3 academic cancer centers. Data collected included demographics, comorbidities, staging, treatments, and survival. The primary endpoint was overall survival (OS). We assessed factors associated with treatment choice and OS. Results A total of 158 patients were included: the median age was 74 years (range, 50‐91 years), 44% were female, and 68% had a performance status of 0 to 1. The stage II groupings of the patients were T2b‐T3 N0 in 55% and N1 in 45%. The most common reasons for inoperability were inadequate pulmonary reserve (27%) and medical comorbidities (24%). All patients received radical radiotherapy (RT) (median, 60 Gy [range, 48‐75 Gy]). Seventy‐three percent received RT alone; 24% received concurrent and 3% sequential chemoradiotherapy (CRT). In multivariate analyses, CRT was less likely in older patients (≥ 70 years) (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.11‐0.70; P = .006) and in patients with higher (> 5) Charlson comorbidity scores (OR, 0.34; 95% CI, 0.13‐0.90; P = .03) or normal (< 10 × 109/L) white blood cell counts (OR, 0.26; 95% CI, 0.09‐0.73; P = .01). At the time of our analysis, 74% have died. The median OS was 22.9 months (range, 17.1‐26.6 months). Patients who had undergone CRT had a significantly longer median OS than those receiving RT alone (39.1 vs. 20.5 months; P = .0019), confirmed in multivariate analysis (hazard ratio, 0.38; 95% CI, 0.21‐0.69; P = .001). Conclusion Nonsurgical approaches to management of stage II NSCLC are varied. Treatment with CRT was associated with significantly longer survival compared with RT alone. A randomized trial may be warranted. Micro‐Abstract The optimal nonoperative management of stage II non–small‐cell lung cancer is undefined, with limited data to guide decision‐making in this setting. We reviewed treatment patterns and outcomes of 158 patients in this defined group. The majority (73%) received radical radiotherapy alone; however, those treated with combined‐modality chemoradiation had significantly longer median survival (39.1 vs. 20.5 months; P = .0019). A randomized trial is warranted.

Beyond the black box of geriatric assessment: Understanding enhancements to care by the geriatric oncology clinic

OBJECTIVE Comprehensive geriatric assessment (CGA) of older adults with cancer aids treatment decision-making and prognostication. Much less is known about the supportive care elements or enhancements to care afforded by the CGA. We characterized the enhancements to care provided by a geriatric oncology clinic and determined how these vary by indication for referral. MATERIALS AND METHODS All patients age 65 or older referred to a single academic geriatric oncology clinic between July 2015 (clinic opening) and June 2017 were included. Treatment enhancements were prospectively recorded in 5 categories: educational support, comorbidity management, symptom management, oncologic treatment delivery, and peri-operative management recommendations. Indications for referral were categorized into 3 groups: pre-treatment (n = 97, 44%), on active treatment (n = 89, 41%), and survivorship phase (n = 33, 15%). Data were analyzed using descriptive statistics and multivariable logistic regression. RESULTS 219 patients were seen during the study period (mean age 79.7 years, 69% male). Overall, educational support (96%) and comorbidity management (95%) were the most common enhancements, whereas peri-operative management (10%) was the least common and provided only to pre-treatment patients. Enhancements to cancer treatment delivery were offered more often to patients pre-treatment than on active treatment (61% versus 41%, p < 0.001). Other enhancements to care did not vary by indication for referral. CONCLUSION Educational support and comorbidity management are nearly universally offered. Most enhancements to care do not vary by indication for referral. Understanding the enhancements to care provided by geriatric oncology clinics can help with resource planning and program design.

Prognostic and predictive clinical factors in patients with metastatic castration-resistant prostate cancer treated with cabazitaxel

INTRODUCTION Cabazitaxel is one of several treatment options available for patients with metastatic castration-resistant prostate cancer who have progressed on docetaxel. Little is known about clinical factors that influence prognosis or treatment response for patients receiving cabazitaxel. Identifying prognostic and predictive factors could contribute to the optimal selection of patients for treatment after docetaxel. METHODS A retrospective review of patients enrolled on the cabazitaxel Canadian Early Access Program (C-EAP) was performed. Clinical factors were analyzed by univariable and multivariable Cox proportional hazards and logistic regression analysis to identify independent predictors of prognosis and response. RESULTS Forty-five patients from five centres in Canada were included in this study. On multivariable analysis, lower hemoglobin was associated with shorter survival. No other factors were independently associated with survival, prostate-specific antigen (PSA) response, or primary PSA progression. CONCLUSIONS Clinical factors predicting survival or treatment response were not identified for men with castration-resistant prostate cancer receiving cabazitaxel. Larger studies may be necessary to identify clinical factors and biomarkers that identify whether patients should or should not receive cabazitaxel.

A retrospective analysis of clinical factors influencing response to treatment with cabazitaxel in patients with metastatic castration resistant prostate cancer.

281 Background: The TROPIC trial demonstrated that cabazitaxel improves overall survival (OS) in mCRPC patients progressing on or after docetaxel; a setting where both abiraterone and enzalutamide are also approved. We evaluated baseline factors that may help predict prostate specific antigen (PSA) response or PSA progression defined as per the Prostate Cancer Clinical Trials Working Group 2 (PCWG2) criteria and OS in mCRPC patients treated with cabazitaxel. Methods: Forty patients from five centres participated in an early access program and were retrospectively reviewed to capture baseline characteristics, disease history, prior and subsequent treatments, PSA response, and OS. The influence of selected variables on PSA response and OS were evaluated by univariate and multivariate stepwise regression analysis. Results: At cabazitaxel initiation, median age was 65, ECOG 0-1 (90%), median PSA was 216 ng/mL, 25% had visceral disease and 70% had pain. Median number of prior docetaxel cycles was 9 and median ...