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G. Fora



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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-015 - The role of WALCE (Women Against Lung Cancer in Europe) in helping patients and their caregivers to cope with cancer. (ID 1119)

      09:30 - 09:30  |  Author(s): G. Fora

      • Abstract

      Background
      The diagnosis and treatment of cancer are traumatic events for patients with cancer and their families. It can be a time of a emotional distress for both and can evoke a wide range of emotions related to poor quality of life. The expression of these feelings is crucial in order to cope with a diagnosis of cancer and with treatment side effects and any action where people perceive that they’re moving those feelings outside may be beneficial to them emotionally and physically. Even patients who receive the best support from family and friends may need to connect with other patients, who are facing the same challenges. Patients may seek emotional and/or practical support from cancer patient organizations and find programs designed with the aim to help them and their families to alleviate the emotional concerns.

      Methods
      During the last five years, WALCE addressed their emotional care needs designing programs to ameliorate the cancer patient quality of life during the treatments. These projects are addressed to caregivers too and are observational studies. - The Look Good ... Feel Better® is active in 25 countries worldwide. WALCE started its collaboration with “La forza e il sorriso – L.G.F.B. Italia” in 2009. From March 2009 to June 2013, 68 make-up workshops were organised at the San Luigi Hospital (Orbassano, Italy) in collaboration with five local cancer centres. 487 ladies attended, guided by 7 voluntary beauticians, with the support of a psycho-oncologist. - Relaxation technique sessions may be helpful to face with stress. They are intended to promote physical, emotional and mental relaxation to get a better recovery of energies. From March 2012 to May 2013, 12 sessions were organised and 28 people attended. - Natural cooking classes are a good opportunity for patients and caregivers to learn that the health is closely related with nutrition and actively get involved during the preparation of food. The natural cuisine plays a key role in healthcare and these lessons provide useful tips for a balanced diet. Participating in these classes can empower people affected by cancer to learn vital skills that enable them to regain control, reduce isolation and restore hope. - Mindfulness Based Intervention (MBI) based on the assumption that a non-judgmental awareness and acceptance of one’s moment-to-moment experience have an effect on the distressing tendencies to escape from or to over-engage with one’s disturbing feelings, emotions and thoughts. MBI can positively impact on coping strategies and on the adaptation to the disease, by encouraging patients to relate differently to their physical and psychological symptoms.

      Results
      NOT APPLICABLE

      Conclusion
      Cancer patients tend to cope better with the illness and daily-life when self-confidence is regained. The sense of well-being shared in a relaxed atmosphere a acknowledging social, emotional and psychological needs, whilst being amongst other people with the same fears or anxieties, is an incentive to fight against cancer. It is important to know that there are ways to relieve the discomfort of most treatment-related side effects and to prevent them from becoming severe.

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    P3.06 - Poster Session 3 - Prognostic and Predictive Biomarkers (ID 178)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P3.06-026 - Thymidylate synthase (TS) mRNA and protein expression in advanced non-small cell lung cancer (NSCLC) patients treated with pemetrexed-based therapy. (ID 2355)

      09:30 - 09:30  |  Author(s): G. Fora

      • Abstract

      Background
      In NSCLC, higher Thymidylate Synthase (TS) levels have been reported in both squamous and large cell carcinomas compared to adenocarcinoma. In clinical practice, Pemetrexed, a potent antifolate inhibitor of TS, showed a selective benefit in patients with "non-squamous" NSCLC. Two retrospective studies have shown that low TS protein levels are associated with better clinical outcome in NSCLC patients treated with pemetrexed. Aim of this study was to explore, in a series of advanced stage IV patients receiving pemetrexed-based regimens in first line of treatment, the association between TS mRNA and protein expression with overall survival (OS) and therapeutic response.

      Methods
      Two series of histologically confirmed non squamous-NSCLC, assessed in formalin-fixed and paraffin embedded specimens from patients treated with pemetrexed-based regimens were collected: the first series at San Luigi Hospital (n=64), the second series at Regina Elena National Cancer Institute (n=8). Due to the limited amounts of tissue specimens available, total RNA extraction was possible in 52 out of 72 cases. TS protein expression was performed using immunohistochemistry (mouse monoclonal TS106 antibody) and scored through H-SCORE method, considering both staining intensity (0 no staining; +1 weak; +2 moderate; or +3 strong) and percentage of tumor cells stained, resulting in semiquantitative H-scores ranging from 0 to 300. TS nuclear and cytoplasmic staining, respectively, were separately scored. Statistical analyses were performed using the STATISTICA10 software.

      Results
      The differential H-SCORE assessment showed a strong importance of TS localisation for clinical outcome prediction: in Cox regression analysis, a statistically significant association was observed between nuclear TS expression and OS (p < 0.009) indicating that lower nuclear TS expression levels were associated with longer OS. In addition, lower nuclear TS levels were significantly associated with a better response to therapy (p<0.001). On the contrary, TS cytoplasmic staining did not affect patients’ survival or clinical response (p>0.05). Four subgroups of patients, based on the dichotomized low/high TS expression in both nucleus and cytoplasm, were obtained: both high, both low, nucleus high/cytoplasm low and nucleus low/cytoplasm high. Significant differences in overall survival among these four groups were detected (p=0.017), confirming the strong and selective influence of nuclear TS, as compared to cytoplasmic TS, expression in clinical outcome. Moreover, Chi[2] test revealed a significant association between low nuclear TS and partial response to pemetrexed treatment, independently of cytoplasmic TS expression (p<0.001). No correlation between TS protein expression data and clinico-pathological data (age, gender) were identified. TS gene expression analyses are ongoing.

      Conclusion
      This retrospective study suggests that TS protein expression, selectively assessed at nuclear level, has a potential predictive role in advanced stage IV patients, receiving pemetrexed in first line of treatment. Patients with low nuclear TS expression showed prolonged overall survival and better response to therapy. Such preliminary results define TS assessment as a potential tool which may select the most appropriate group of patients to be treated with pemetrexed.