Lung Cancer

PV 01 - Poster Viewing Q&A - Session 1

SU_25_3168 - Concurrent Aspirin Use Is Associated with a Trend in Improved Overall Survival in Early Stage Lung Cancer Patients Undergoing SBRT: A Retrospective Review

Sunday, September 15
1:15 PM - 2:30 PM
Location: ASTRO Innovation Hub

Concurrent Aspirin Use Is Associated with a Trend in Improved Overall Survival in Early Stage Lung Cancer Patients Undergoing SBRT: A Retrospective Review
G. M. Hermann1, S. J. Ma1, A. J. Iovoli2, M. A. Cummings3, L. Serra2, M. K. Farrugia1, J. A. Gomez Suescun1, and A. K. Singh1; 1Roswell Park Comprehensive Cancer Center, Buffalo, NY, 2Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, 3University of Rochester Medical Center, Rochester, NY

Purpose/Objective(s): Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin (ASA) are commonly prescribed medications with anti-inflammatory and anti-platelet properties used long-term to decrease the risk of cardiovascular events. Prior studies have shown a mortality benefit for ASA use for patients across a wide range of cancers. In patients with non-small cell lung cancer (NSCLC) undergoing definitive radiation, the receipt of ASA has been associated with a trend in survival benefit. The aim of the current study was to evaluate the effect of ASA on patients with NSCLC undergoing stereotactic body radiation therapy (SBRT) for early-stage lung cancer. Hypothesis: Patients on ASA undergoing SBRT for NSCLC will have improved survival.

Materials/Methods: This was an IRB-approved single institution retrospective review of patients with peripherally located early-stage NSCLC who had undergone SBRT from 2007 to 2015. Patient characteristics including concurrent NSAID, ASA, and anticoagulant use were abstracted. The effect of NSAID and ASA use on patterns of failure were compared with Fischer’s exact test. Survival trends for overall survival (OS) were estimated using Kaplan-Meier survival curves and examined using multivariate cox proportional hazard regression models (MVA). Data and decision management software was used for analyses.

Results: At a median follow-up of 18.2 months, 164 patients were eligible. 74 (45%) were taking NSAIDs and of those 70 (95%) were taking ASA at time of SBRT. The median age was 76y (range: 53-94y), 95 (58%) patients received 48-60Gy in 3 fractions, 69 (42%) received 30Gy in 1 fraction, and 43 (26%) patients were on anticoagulants . There was no statistically significant difference in OS comparing concurrent NSAID use vs. no NSAID (log rank p=0.12). There was a near significant OS benefit favoring concurrent ASA use vs. no ASA (log rank p=0.057). The median OS and 2-year OS for ASA+ vs. ASA- was 2.4y vs 2.0y and 57% vs 48%, respectively. After adjusting for concurrent anticoagulant use, KPS, age, and smoking history on MVA, there was no statistically significant benefit in OS for ASA. There was no significant difference between ASA+ and ASA- in local failure (7.3% vs 4.9%, p=1.0), regional failure (9.2% vs 7.9%, p=0.68), or distant failure (11% vs 12.2%, p=0.19), respectively

Conclusion: This study suggests a potential OS advantage for patients taking ASA during SBRT for NSCLC. Because there was no OS benefit seen after MVA, these results may reflect mortality from unaccounted confounding factors. This study is consistent, however, with a growing body of evidence demonstrating improved survival outcomes with ASA and NSAID use in cancer patients. Implications for practice or research: ASA may offer a survival advantage to patients treated for lung cancer with radiation. Further clinical and pre-clinical studies examining this effect are warranted.

Author Disclosure: G.M. Hermann: None. S. Ma: None. A.J. Iovoli: None. M.A. Cummings: None. L. Serra: None. J. Gomez Suescun: None.

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