Abstract 4228: Incidence of pericardial and pleural effusions in patients with small cell lung cancer treated with third-line or later-line therapy: An analysis of electronic health records data
Authors: Jiang Rui , Gulbranson Scott H. , Bhattacharya Mondira , Lievano Fabio A. , Komarnitsky Philip , Koch Martina M. , Potluri Ravi , Tyczynski Jerzy E. 
Published: August 2018

Small cell lung cancer (SCLC) is an aggressive, rapidly fatal disease. Pericardial and pleural effusions are, to a large extent, part of the natural history of lung cancer and the occurrences in SCLC may have differed due to novel therapies. We estimated the incidence of treatment-emergent pericardial and pleural effusions in SCLC patients treated with third-line or later-line therapy using Optum's electronic health records (EHR) data. The database consists of de-identified EHR data from a network of healthcare provider organizations in the United States. Natural language processing (NLP) was used to identify SCLC. Of 8,291 patients with newly diagnosed SCLC between 01/01/2008 and 09/30/2016 who met our inclusion criteria, 428 patients received 3rd line of therapy (LOT). 206 LOTs were 4th or later lines. Pericardial and pleural effusions were identified by a combination of ICD-9/ICD-10, procedures, or terms from NLP structured data. At start of 3rd LOT, median age was 65, 46% were male, 97% had extensive disease (excluding n=52 with missing staging). The incidence rate was 1.58 (95% CI, 1.17-2.07) per 1,000 person-days for pericardial effusion and 4.40 (95% CI, 3.67-5.25) for pleural effusion in patients with 3rd LOT while on-treatment (Table 1). The incidence rate was 1.15 (95% CI, 0.88-1.49) for pericardial effusion and 3.68 (95% CI, 3.12-4.32) for pleural effusion in patients with 3rd LOT while on-treatment and off-treatment. Patients treated with 4th or later lines had higher incidence of pericardial and pleural effusions compared to patients treated with 3rd LOT. The incidence proportions of the effusions (Table 1) should be interpreted with care, as the patients had varying length of follow-up. In conclusion, this analysis is the first, to our knowledge, to provide population-based estimates of incidence for pericardial and pleural effusions in SCLC patients treated with third- or later-line therapy.

Table 1. Incidence of pericardial and pleural effusionsIncidence Proportion % (95% CI)Incidence Rate per 1,000 Person-Days (95% CI)On-treatment* 3rd LOT (n=428)Pericardial (n=51)11.9% (9.00-15.4%)1.58 (1.17-2.07)Pleural (n=125)29.2% (24.9-33.8%)4.40 (3.67-5.25)4th+ LOT(n=206)Pericardial (n=32)15.5% (10.9-21.2%)2.14 (1.46-3.01)Pleural (n=66)32.0% (25.7-38.9%)5.49 (4.25-6.99)On-treatment and off-treatment**3rd LOT(n=428)Pericardial (n=59)13.8% (10.7-17.4%)1.15 (0.88-1.49)Pleural (n=152)35.5% (31.0-40.3%)3.68 (3.12-4.32)4th+ LOT(n=206)Pericardial (n=37)18.0% (13.0-23.9%)1.49 (1.05-2.05)Pleural (n=80)38.8% (32.1-45.9%)4.14 (3.28-5.15)*from start of LOT to earlier of (30 days after end of LOT or start of next LOT); **from start of LOT to the day prior to start of next LOT or earlier of (365 days from end of LOT or loss to follow-up date), if there is no subsequent LOT; for those with the event, time to first occurrence was used

Citation Format: Rui Jiang, Scott H. Gulbranson, Mondira Bhattacharya, Fabio A. Lievano, Philip Komarnitsky, Martina M. Koch, Ravi Potluri, Jerzy E. Tyczynski. Incidence of pericardial and pleural effusions in patients with small cell lung cancer treated with third-line or later-line therapy: An analysis of electronic health records data [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4228.