2442 - Charlson Comorbidity Index as a Predictive Tool of Treatment Tolerance and Outcomes in Elderly Non-Small Cell Lung Cancer Patients Treated with Concurrent Proton or Photon Chemoradiation Followed by Immunotherapy
Presenter(s)
C. Y. Mollings Puentes1, Y. M. Sasaki2, T. Xu3, S. Koutroumpakis2, A. Sheshadri2, A. Deswal2, Q. N. Nguyen4, D. C. Qian3, J. K. Bronk3, S. Gandhi2, T. Cascone5, X. Le6, M. Altan7, A. B. Chen3, and Z. Liao3; 1Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 3Department of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 4The University of Texas MD Anderson Cancer Center, Houston, TX, 5University of Texas MD Anderson Cancer Center, Houston, TX, 6Department of Thoracic-Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 7Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Purpose/Objective(s): Comorbidities can impact the prognosis and treatment response of patients undergoing cancer care. The Charlson Comorbidity Index (CCI) is a widely used measure that can predict mortality. CCI generates scores that stratify the comorbidity burden of patients as mild, moderate, and severe. NSCLC patients have a median age of 70 years and numerous comorbidities. This study utilized CCI as a clinical tool to risk-stratify and predict survival outcomes in elderly NSCLC patients undergoing concurrent chemoradiation (CRT) using proton beam therapy (PBT) or intensity-modulated radiation therapy (IMRT) followed by immunotherapy (IO).
Materials/Methods: This is a retrospective review of senior patients (= 65 years) with inoperable locally advanced NSCLC who received concurrent CRT followed by adjuvant IO. The CCI grades comorbidities based on hazard ratios of death and scores are classified as mild (1-2); moderate (3–4) and severe (=5). Treatment tolerance included the rate of hospitalization, emergency room visits, toxicities, and immunotherapy completion. The association between treatment tolerance and severe CCI classification was analyzed using logistic regression. Cox proportional hazards regression was used to determine the association between severe CCI scores and survival outcomes.
Results: A total of 218 patients with a median age of 72 (range 65- 86) were included. The majority of patients identified as white (85%) and male (56%) with ECOG scores of 0-1 (94%). Most patients had stage III adenocarcinoma disease (86%). The median follow-up time was 23 months. More than 90% of patients had =1 comorbidity and 62% had = 4 comorbidities (n=135, range 0-11). Rates of hospitalization and ER visits during CRT+IO were 28% and 5%. Higher hospitalization rates after CRT were related to severe CCI (p=0.002, OR=2.36, 95% CI: 1.75, 12.79). Severe CCI was related to higher hospitalization and ER visits during CRT and IO (p=0.01, OR=2.40; 95% CI: 1.25, 4.61). The toxicities with the highest incidence were esophagitis (grade 1=3.2%, grade 2=69%, grade 3= 5.5%, n=169), pleural effusion (61%, n=133) and pulmonary fibrosis (n=114, 52%). Severe CCI was only associated with esophagitis (p=<0.001, 95% CI: 2.40,3.81). There was no association between severe CCI and PFS, LRFS, or DMFS. A lower OS was associated with a higher CCI score (p=0.0015) and severe CCI classification (p=0.04). The OS rate between patients with severe CCI or mild-moderate CCI diverges approximately 20 months after completing CRT+IO.
Conclusion: Severe CCI was associated with higher rates of esophageal toxicity, hospitalization, and ER visits and plays a valuable role in predicting OS.