P2.17-09 Exploring the Impact of Age on the Efficacy of Adjuvant Chemotherapy After Radical Resection in Non- Small Cell Lung Cancer

Abstract

Most adults diagnosed with Non Small Cell Lung Cancer (NSCLC) are over 65 years old. For those with resectable disease postoperative cisplatin-based chemotherapy (PC) has been shown to offer a significant survival advantage. However elderly patients are poorly represented in clinical trial cohorts, here we shall explore our regional experience of treating these patients. Patients receiving PC with Vinorelbine 25mg/m2, D1 and 8/ Cisplatin 75mg/m2 (VC) following surgery for NSCLC between January 2004 and April 2017 were identified from the electronic computer database. Patients with synchronous tumours or metastatic disease were excluded. 165 patients were identified, 63 (38%) ≥65yrs (range 65-77yrs). All were ECOG PS 0-1. 12 patients had Stage 1B disease (7 ≥65yrs), 63 Stage II A (20 ≥65yrs), 40 Stage IIB (21 >65yrs) and 50 Stage IIIA/B disease (17 >65yrs). 53.9% of patients ≥ 65yrs compared to 81% patients < 65yrs completed 4 cycles of PC.19% of patients required dose reductions due to toxicity, 12 were over 65yrs. Grade 3/4 neutropenia occurred in 21.2% of patients (18<65yrs vs. 17 ≥65 yrs) and febrile neutropenia in 9 patients ≥ 65yrs vs. 11<65yrs. No toxic deaths were recorded. Overall 85 (51.5%) patients, 26 ≥65yrs had radiological evidence of disease recurrence. The median time to recurrence was 26.19 months, no significant difference was found in time to relapse based on age (p=0.21). Kaplan Meyer analysis revealed no significant difference in overall survival based on age (p=0.77, HR1.069 95%CI 0.68-1.67). Mortality 6 months post chemotherapy in patients ≥ 65yrs was 1.58% vs. 2.94% inpatients < 65yrs. This illustrates in routine practice, PC using VC is deliverable in older patients of good PS with resected NSCLC. Though they may experience more toxicity from PC the benefits in terms of disease recurrence and overall survival were equivalent to patients <65yrs.