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A. Boufas



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    P2.10 - Poster Session 2 - Chemotherapy (ID 207)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P2.10-005 - Erlotinib (E) can be safely administered in pts > 80 years old (ID 345)

      09:30 - 09:30  |  Author(s): A. Boufas

      • Abstract

      Background
      Besides chemotherapy, E is another option in NSCLC pts especially in those with EGFR mutations. Elderly pts enrolled in trials are fit without cM, but in clinical practice most suffer from cM.

      Methods
      Medical records of 1221 pts diagnosed with NSCLC between 2008-2012 were screened. We examined pts ≥75 yrs for demographics, clinical data and Tx details.

      Results
      233/1221 NSCLC pts received E at any line. 53/233 (23%) were ≥75 yrs old. Male:female ratio was 34:19 and median age 79 yrs (range 75-88). NSCLC subtypes included 31 adenoca, 8 squamous cell, 9 NOS and 5 others. 50/53 pts had cM (≥2 in 46 pts, 1 in 4pt). Main cM were cardiovascular disease (n=41), COPD (n=14), other cancer (n=10) and diabetes (n=8). 8 pts were tested for EGFR mutations (5 -ve, 3 +ve). Performance Status was satisfactory (ECOG 0-1) in 8 pts and poor (2-3) in 45pts. 8pts were treated with E 100mg and 45 pts with E 150mg (12 pts needed dose reduction). Complete follow up data were found in 46pts. Mean duration of treatment was 79 days (range 9-662). 35/46 pts experienced side effects (s.e) [rash n=29, diarrhea n=17] which led to treatment discontinuation in 12pts. Pts with abnormal creatinine clearance (n=13) were more likely to stop treatment due to s.e (6/13 versus 6/33). 17/46 pts (37%) achieved disease control (5 PR, 12 SD) and a time to progression (TTP) of 157 days (range 106-662, 95% CI 132.79-270,74) while 22/46 pts had PD as best response (TTP 49d, range 19-88, CI 44,67-64,97). 7pts were not evaluable (stopped Tx due to s.e). All EGFR+ve pts had disease control (2PR, 1SD).

      Conclusion
      E is a valuable option in elderly NSCLC patients with co-morbidities, especially if they harbor EGFR mutations. Impaired renal function might be associated with propensity to side effects and earlyTx discontinuation.

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    P3.14 - Poster Session 3 - Mesothelioma (ID 197)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Mesothelioma
    • Presentations: 1
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      P3.14-002 - Second Line- Chemotherapy Treatment Options, In Malignant Mesothelioma Tumors, Resistant To Pemetrexed. (ID 343)

      09:30 - 09:30  |  Author(s): A. Boufas

      • Abstract

      Background
      The number of patients with Malignant Mesothelioma is expected to increase over the next ten years from the number of 3.300 new cases that are reported annually nowadays. Most of the patients appear with advanced, surgically unresectable disease at the time of diagnosis and relapse is usual after the standard 1st line treatment with a platinum-pemetrexed doublet, due to intrinsic and acquired resistance to pemetrexed. This review focuses on the treatment options in Malignant Mesothelioma resistant to pemetrexed and is based on trials for possible 2nd line regimens tested the last ten years and ongoing trials of novel agents and studies exploring the basis of pemetrexed resistance.

      Methods
      We searched via PubMed/Medline, Clinicaltrials.gov and American Society of Clinical Oncology databases for articles and ongoing trials published until 1/2013 using the term: “mesothelioma”, in association with “2nd line chemotherapy”, “pemetrexed resistance”, “relapsed”, “pemetrexed-pretreated” and “biomarker”. Primary sources have been quoted.

      Results
      Data from forty eight conducted and ongoing trials, mainly phase II, single-armed, but also retrospective and phase III, are shown and discussed. Thirty different agents were tested in these trials as possible 2nd line drugs for Malignant Mesothelioma. Currently, no guidelines for 2nd line chemotherapy in Malignant Mesothelioma tumors resistant to pemetrexed are available.

      Conclusion
      In the absence of a “gold standard” as 2nd line treatment for Malignant Mesothelioma, results of ongoing trials are eagerly awaited and the research for novel agents remains critical. Furthermore, additional research should be done towards the understanding of the mechanisms that lead to pemetrexed resistance, the possible personalization of 1st and 2nd line treatment and the use of biomarkers that can be used as factors predicting the resistance itself. Finally, more patients should be convinced to enroll in clinical trials and more randomized trials have to be conducted.