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C. Zúñiga-Orlich



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    MO10 - Molecular Pathology II (ID 127)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Pathology
    • Presentations: 1
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      MO10.02 - Update genotyping non-small cell lung cancer (NSCLC) in Latin America: Latin-American Consortium for the Investigation of Lung Cancer (CLICaP) (ID 3462)

      16:20 - 16:25  |  Author(s): C. Zúñiga-Orlich

      • Abstract
      • Presentation
      • Slides

      Background
      Previously we reported that the frequency of mutations in EGFR and KRAS in non-small cell lung cancer (NSCLC) is Latinoamerica,finding the frequency of EGFR mutations in Latin-America between Asian (40%) and European (15%) populations. We report the update frequency of mutations in Latin America.

      Methods
      3606 biopsies of NSCLC patients from Latin-America (Argentina, Colombia, México and Peru) were used by extracted genomic DNA which was used to perform direct sequencing of EGFR gene (exons 18 and 21) and KRAS gene in 2385 samples.

      Results
      Of all patients the median age was 62.2 ±12.3, 52.6% were women, and 51% had smoking history. Frequency of EGFR mutations in NSCLC was 24.4% [CI 95% 22.7-24.1] (Argentina 14.4%, Colombia 24.9%, Mexico 34.4%, Peru 67.0%). The frequency of KRAS mutations was 7.1%. EGFR mutations were independently associated with gender (29.8% vs 16.3%; p< 0.001), older age (<60 vs >60; p= 0.001), non-smokers 25.9% vs 15.7%; p= 0.001), ethnicity (Hispanic 37.7%, Caucasic 13%, Afro-American 0%, non-determinate 22.9%; p< 0.001), histology (adenocarcinoma 23.8%, squamous 4.4%, large cells 33.3% and non differenced 22.2%) and absence of KRAS mutation. Overall response rate to tyrosine kinase inhibitors (EGFR-TKIs) in EGFR mutated patients (n=56) was 62.5% [95% CI 50-75] with a median overall survival of 16.5 months [95% CI 12.4-20.6].

      Conclusion
      Our findings confirm the high frequency of EGFR Mutation in Latino-america and low frequency of K-RAS mutation, particularly in patients of Hispanic ethnicity. Differences in risk factors associated with lung cancer in our population and ethnic variability could explain these findings.

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    P1.06 - Poster Session 1 - Prognostic and Predictive Biomarkers (ID 161)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P1.06-019 - Common and uncommon EGFR mutations and their impact on response to EGFR tyrosine-kinase inhibitors and platinum-based chemotherapy in non-small cell lung cancer (NSCLC): Latin-American Consortium for the Investigation of Lung Cancer (CLICaP) (ID 1728)

      09:30 - 09:30  |  Author(s): C. Zúñiga-Orlich

      • Abstract

      Background
      An association has been well-established between common EGFR mutations and response to reversible and irreversible direct EGFR tyrosine-kinase inhibitors (EGFR-TKIs); however, there is a significant lack of information about the impact of uncommon mutations on outcomes such as overall response (OR), progression-free survival (PFS) and overall survival (OS) rates after being exposed to EGFR-TKIs or platinum-based chemotherapy (CT).

      Methods
      Information regarding 186 NSCLC patients from three Latin-American countries was analysed. Tests were made for EGFR and KRAS mutations; the clinical and pathological characteristics and the presence of common and uncommon EGFR mutations were considered according to OR, PFS and OS rates concerning EGFR-TKIs and CT.

      Results
      79.5% of the patients had common EGFR mutations and 20.5% uncommon mutations, including complex alterations. Lepidic and acinar histological subtypes were associated with higher common EGFR mutation frequency (p= 0.010). Patients having an OR to EGFR-TKIs treatment also had an OR to CT (p< 0.001). Patients harbouring common EGFR mutations had greater sensitivity to EGFR-TKIs than those having uncommon mutations (63.8% [IC 95% 51.1-76.5] vs 32.4% [20.0-44.7] p< 0.0001). Median PFS regarding EGFR-TKIs (16.4 [12-21.1] vs 4.1 months [1.9-5.9]) and CT (16 [10.9-21] vs 4.3 months [0.9-12.9]) was better in patients having common EGFR mutations compared to patients carrying uncommon mutations. The median OS of patients treated with EGFR-TKIs that harbored common EGFR mutations (37.3 months [33.2-41]) was longer compared to those patients who harbored uncommon mutations (17.4 months [12.9-21.8]).

      Conclusion
      Our findings suggest that patients with EGFR uncommon mutations, could receive platinum-based chemotherapy as first line of treatment and EGFR-TKIs can be reserved as second or third line treatment options.

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    P1.24 - Poster Session 1 - Clinical Care (ID 146)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P1.24-043 - Results of a Multidisciplinary Team in the Management of Non-Small Cell Lung Cancer in a Developing Country (ID 3041)

      09:30 - 09:30  |  Author(s): C. Zúñiga-Orlich

      • Abstract

      Background
      Lung cancer has the highest cancer-related mortality in the World. In developing countries, mortality rates tend to be higher due to deficits of diagnostic and professional resources, and long time intervals between patient’s symptoms and the initiation of treatment. Multidisciplinary teams improve the care of patients with NSCLC, but this practice is not common in developing countries. In Costa Rica more than 90% of cancer patients are treated in a public hospital where resources are limited. To improve patient care a weekly multidisciplinary thoracic oncology meeting was organized in Hospital San Juan de Dios, one of Costa Rica’s three adult general hospitals. This hospital is responsible for the management of more than 40% of Costa Rica’s cancer patients.

      Methods
      A multidisciplinary team including Medical Oncology, Pneumology, Pathology, Thoracic Surgery, Radiology and Radiation Oncology started to meet in a weekly basis since November 2011. All patients with a possible lung cancer in the hospital were evaluated by the team and recommendations were given. Data of patients with NSCLC seen by the multidisciplinary team during 2012 was compared to a historic data of NSCLC patients diagnosed in the same hospital between 2003 and 2008 when there was no multidisciplinary team involved in patient care. Exclusion criteria included insufficient clinical information. Epidemiologic data was analyzed and survival curves were obtained.

      Results
      In the periods 2003-2008 and 2012, 92 and 39 patients respectively with NSCLC were included for analysis. Epidemiologic results are summarized in Table 1 and overall survival is plotted in Figure 1. Figure 1 Figure 2

      Conclusion
      The inclusion of a multidisciplinary team in the management of NSCLC lead to an earlier diagnosis and increased survival of patients. This approach should be considered in the management of NSCLC patients in a developing country.