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International audience; Purpose: Maintenance chemotherapy is a reasonable choice for patients with metastatic non-small cell lung carcinoma (NSCLC) not progressing after induction therapy with a platinum-based doublet. Nevertheless, there have been no studies dedicated to elderly patients.Patients and methods: We conducted a randomised trial in patients aged 70-89 years, with advanced NSCLC (with neither EGFR mutation nor ALK rearrangement), who had not progressed after four cycles of monthly carboplatin and weekly paclitaxel in order to compare maintenance with either pemetrexed (500 mg/m2 d1, 22) in patients with non-squamous cell carcinoma or gemcitabine (1,150 mg/m2 d1, 8, 22) in squamous cell carcinoma to simple observation. The patients were required to have a performance status (PS) 0-2, mini-mental score >23, and creatinine clearance ≥45 mL/min. The primary end-point was overall survival (OS).Results: 632 patients were enrolled from May 2013 to October 2016. Of the 328 (52.3%) patients randomised after induction therapy, 166 patients were assigned to the observation arm, versus 162 to the switch maintenance arm, 119 of whom received pemetrexed and 43 gemcitabine. The median OS from randomisation was 14.1 months (95% confidence interval [CI]: 12.0-17.0) in the observation arm and 14 months (95% CI: 10.9-16.9) in the maintenance arm (p = 0.72). The median progression-free survival (PFS) from randomisation was 2.7 months (95% CI: 2.6-3.1) in the observation arm versus 5.7 months (95% CI: 4.8-7.1) in the maintenance arm (p < 0.001).Conclusion: Switch maintenance therapy significantly prolonged PFS but not OS and, thus, should not be proposed to elderly patients with advanced NSCLC.

Summary Background Topotecan is currently the only drug approved in Europe in a second-line setting for the treatment of small-cell lung cancer. This study investigated whether the doublet of carboplatin plus etoposide was superior to topotecan as a second-line treatment in patients with sensitive relapsed small-cell lung cancer. Methods In this open-label, randomised, phase 3 trial done in 38 hospitals in France, we enrolled patients with histologically or cytologically confirmed advanced stage IV or locally relapsed small-cell lung cancer, who responded to first-line platinum plus etoposide treatment, but who had disease relapse or progression at least 90 days after completion of first-line treatment. Eligible patients were aged 18 years or older and had an Eastern Cooperative Oncology Group performance status 0–2. Enrolled patients were randomly assigned (1:1) to receive combination carboplatin plus etoposide (six cycles of intravenous carboplatin [area under the curve 5 mg/mL per min] on day 1 plus intravenous etoposide [100 mg/m2 from day 1 to day 3]) or oral topotecan (2·3 mg/m2 from day 1 to day 5, for six cycles). Randomisation was done using the minimisation method with biased-coin balancing for ECOG performance status, response to the first-line chemotherapy, and treatment centre. The primary endpoint was progression-free survival, which was centrally reviewed and analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov , NCT02738346 . Findings Between July 18, 2013, and July 2, 2018, we enrolled and randomly assigned 164 patients (82 in each study group). One patient from each group withdrew consent, therefore 162 patients (81 in each group) were included in the intention-to-treat population. With a median follow-up of 22·7 months (IQR 20·0−37·3), median progression-free survival was significantly longer in the combination chemotherapy group than in the topotecan group (4·7 months, 90% CI 3·9–5·5 vs 2·7 months, 2·3–3·2; stratified hazard ratio 0·57, 90% CI 0·41–0·73; p=0·0041). The most frequent grade 3–4 adverse events were neutropenia (18 [22%] of 81 patients in the topotecan group vs 11 [14%] of 81 patients in the combination chemotherapy group), thrombocytopenia (29 [36%] vs 25 [31%]), anaemia (17 [21%] vs 20 [25%]), febrile neutropenia (nine [11%] vs five [6%]), and asthenia (eight [10%] vs seven [9%]). Two treatment-related deaths occurred in the topotecan group (both were febrile neutropenia with sepsis) and no treatment-related deaths occurred in the combination group. Interpretation Our results suggest that carboplatin plus etoposide rechallenge can be considered as a reasonable second-line chemotherapy option for patients with sensitive relapsed small-cell lung cancer. Funding Amgen and the French Lung Cancer Group (Groupe Francais de Pneumo-Cancerologie).

Purpose Second-line chemotherapy regimens have demonstrated poor benefit after failure of platinum-based chemotherapy in advanced non-squamous non–small-cell lung cancer (nsNSCLC). Methods In this multicentre, open-label phase III trial, patients with advanced nsNSCLC treated with one or two prior lines, including one platinum-based doublet, were centrally randomised to receive 90 mg/m2 of paclitaxel (D1, D8, D15) plus 10 mg/kg of bevacizumab (D1, D15) every 28 days or docetaxel (75 mg/m2) every 21 days; crossover was allowed after disease progression. Primary end-point was progression-free survival (PFS). ClinicalTrials.gov registration number: NCT01763671 . Results One hundred sixty six patients were randomised (paclitaxel plus bevacizumab: 111, docetaxel: 55). The median PFS was longer in patients receiving paclitaxel plus bevacizumab than in patients receveing docetaxel [5·4 months versus 3·9 months, adjusted hazard ratio (HR) 0·61 (95% confidence interval [CI]: 0·44–0·86); p = 0·005]. Objective response rates (ORRs) were 22·5% (95% CI: 14·8–30·3) and 5·5% (95% CI: 0·0–11·5) (p = 0·006), respectively. Median overall survivals were similar (adjusted HR 1·17; p = 0·50). Crossover occurred in 21 of 55 (38·2%) docetaxel-treated patients. Grade III-IV adverse events (AEs) were reported in 45·9% and 54·5% of patients treated with paclitaxel and bevacizumab or docetaxel, respectively (p = NS), including neutropenia (19·3% versus 45·4%), neuropathy (8·3% versus 0·0%) and hypertension (7·3% versus 0·0%). Three patients died due to treatment-related AEs (1·8% in each group). Conclusion Weekly paclitaxel plus bevacizumab as second- or third-line improves PFS and ORR compared with docetaxel in patients with nsNSCLC, with an acceptable safety profile. These results place weekly paclitaxel plus bevacizumab as a valid option in this population. Clinical trials registration number ClinicalTrials.gov Identifier: NCT01763671 .

Purpose: The incidence of lung cancer has dramatically increased in women. Preclinical data have suggested that combining EGFR–tyrosine kinase inhibitor (TKI) with an antiestrogen may overcome resistance to EGFR-TKI. Patients and Methods: The IFCT-1003 LADIE trial was a 2 × 2 arms parallel open-label randomized phase II trial. EGFR-TKI–naïve postmenopausal women with advanced lung cancer were treated with gefitinib (G) versus gefitinib + fulvestrant (G+F) in the EGFR-mutated group (EGFR+) or with erlotinib (E) versus erlotinib + fulvestrant (E+F) in the EGFR wild-type group (EGFR-WT). The primary objective was progression-free survival (PFS) at 3 and 9 months for EGFR-WT and EGFR+ patients. Results: Overall, 204 patients (gefitinib 104 and G+F 100) and 175 patients (erlotinib 87 and E+F 88) were enrolled in the EGFR+ and EGFR-WT cohorts. In the EGFR+ cohort, the primary endpoint was reached, with 58% of the G+F group patients being nonprogressive at 9 months. Adding fulvestrant to gefitinib was not associated with improved PFS (9.9 vs 9.4 months) or overall survival (OS; 22.1 vs 28.6 months). In the EGFR-WT cohort, the primary endpoint was also achieved (33.7% of the patients were nonprogressive at 3 months). Adding fulvestrant to erlotinib was not associated with improved outcome (PFS 1.8 vs 2.0 and OS 10.3 vs 7.3 months). No PFS difference was observed regarding estrogen receptor alpha expression. The tolerance was as expected with no treatment-related death. Conclusions: Adding fulvestrant to EGFR-TKI is feasible, but not associated with prolonged PFS regardless of EGFR status. The lack of benefits while combining fulvestrant to EGFR-TKI does not support its future development in an unselected population.

Purpose: Second-line chemotherapy regimens have demonstrated poor benefit after failure of platinum-based chemotherapy in advanced non-squamous non-small-cell-lung cancer (nsNSCLC). Methods: In this multicentre, open-label phase 3 trial, patients with advanced nsNSCLC treated with one or two prior lines, including one platinum-based doublet, were centrally randomised to receive paclitaxel 90 mg/m² (D1, D8, D15) plus bevacizumab 10 mg/kg (D1, D15) every 28 days or docetaxel (75 mg/m²) every 21 days; crossover was allowed after disease progression. Primary endpoint was progression-free survival (PFS). Results: Between May 2013 and August 2014, 166 patients were randomized (paclitaxel plus bevacizumab: 111, docetaxel: 55). Median PFS was longer in paclitaxel plus bevacizumab patients than in docetaxel patients [5·4 months vs 3·9 months, adjusted hazard ratio (HR) 0·61 (95% CI 0·44-0·86); p=0·005]. Objective response rates (ORR) were respectively 22·5% (95% CI 14·8-30·3) and 5·5% (95% CI 0·0-11·5) (p=0·006). Median overall survivals were similar (adjusted HR 1·17; p=0·50). Crossover occurred in 21/55 (38·2%) docetaxel-treated patients. Grade 3-4 adverse events were reported in 45·9% and 54·5% of patients treated with paclitaxel and bevacizumab or docetaxel, respectively (p=NS), including neutropenia (19·3% vs 45·4%), neuropathy (8·3% vs 0·0%), and hypertension (7·3% vs 0·0%). Three patients died due to treatment-related adverse events (1·8% in each group). Conclusion: Weekly paclitaxel plus bevacizumab as second- or third-line improves PFS and ORR compared to docetaxel in nsNSCLC patients, with an acceptable safety profile. These results place weekly paclitaxel plus bevacizumab as a valid option in this population. Trial Registration: This trial is registered with ClinicalTrials.gov, number NCT01763671. Funding Statement: The study was sponsored by IFCT. Roche (Boulogne Billancourt, France) supplied bevacizumab, and a complementary grant but had no role in the study design, conduct of the study, and data analysis and had no other involvement in the study. The study was also supported by the French National Cancer Institute (INCa) and French League Against Cancer. Declaration of Interests: ABC has received honoraria from Roche, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, MSD, Novartis, Pfizer, and travel grants from Roche, AstraZeneca, Boehringer Ingelheim, Novartis and Pfizer. CAV has declared grants, personal fees and non-financial support from Roche. OM has declared personal fees from BMS, Boehringer Ingelheim, Astra Zeneca, Novartis, ans Hoffman-Roche. FB has declared personal fees from Astra Zeneca, BMS, Boehringer Ingelheim, Clovis Oncology, Eli Lilly Oncology, Hoffman-Roche, Novartis, Merck, MSD, Pierre Fabre and Pfizer. GZ has declared grant from Roche and BMS, personal fees from Roche, BMS, Astra Zeneca, and MSD, and non-financial support from BMS, Astra Zeneca and Pfizer. DP has declared has declared personal fees from Roche Hoffman, Astellas, Lilly, Janssen, BMS, Merck, Astra Zeneca, Novartis, Sanofi and Pfizer. CFD has declared other from MSD (CPLF 2017), Laidet Medical (ERS 2016), and Boehringer Ingelheim (CPLF 2016). EP has declared personal fees and non-financial support from Astra Zeneca, BMS and personal fees from Pfizer. DMS has declared personal fees from Roche, BMS, MSD and Eli Lilly. BB has received institutional grants for clinical and translational research from AstraZeneca, BMS, Boehringer-Ingelheim, Lilly, Pfizer, Roche-Genentech, Sanofi-Aventis, Clovis, GSK, Servier, EOS, Onxeo, OncoMed, Inivata, OSE Pharma. Ethics Approval Statement: This study was approved by a local Ethic Committee (CPP Nord-Ouest III, France), and complied with French legislation, Good Clinical Practices, and the principles outlined in the latest version of Declaration of Helsinki. After approvals, the study was implemented in 36 hospitals and cancer centres in France.

9097Background: The incidence of lung cancer is increasing dramatically in women with recent findings as the preferential involvement of the EGFR pathway and the potential impact of hormonal factor...

9005Background: Adding bevacizumab to weekly paclitaxel (wPB) has shown synergistic effect and increased activity in various tumor types. The ULTIMATE study evaluated wPB vs. docetaxel (DOC) as 2nd or 3rd-line treatment in patients with advanced non-squamous NSCLC. Methods: Patients with non-squamous NSCLC progressing after 1 or 2 lines of treatment including platinum-based chemotherapy were randomized 2:1 (stratified by PS, previous lines, prior exposure to bevacizumab) to wPB (paclitaxel 90 mg/m² D1, 8, 15 and bevacizumab 10 mg/kg D1, 15, q28d) or DOC (75 mg/m² q21d) until progression. Patients were allowed to cross-over to the other arm following progression. The primary endpoint was progression-free survival (PFS). Results: From 05/2013 to 08/2014, 166 patients were randomized (wPB: 111, DOC: 55). Clinical characteristics were balanced between both arms. 31% had received previous bevacizumab and 69% had received 1 previous line of treatment. Median follow-up was 28.9 months. The adjusted hazard ratio ...

TPS8110 Background: The incidence of lung cancer is increasing dramatically in women and displays some specific epidemiological, radiological, clinical and pathological characteristics. Two main me...

e19110 Background: In the last few years, new drugs and strategies have emerged in the management of lung cancer (LC). ESCAP-2011-CPHG, promoted by the French College of General Hospital Respirator...