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D.O. Cortez
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P1.10 - Poster Session 1 - Chemotherapy (ID 204)
- Event: WCLC 2013
- Type: Poster Session
- Track: Medical Oncology
- Presentations: 1
- Moderators:
- Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P1.10-054 - Reduction levels of Carcinoembryonic antigen as a predictive factor of response to chemotherapy in lung cancer patients with Advanced Non-small-cell lung cancer. (ID 3435)
09:30 - 09:30 | Author(s): D.O. Cortez
- Abstract
Background
High serum carcinoembryonic antigen (CEA) levels are an independent prognostic factor for recurrence and survival in patients with non-small cell lung cancer (NSCLC). Its role as a predictive marker of treatment response with chemotherapy has not been widely characterized.Methods
Two-hundred and fifty patients with advanced NSCLC (stage IIIB or Stage IV), who had an elevated CEA serum level (>10 ng/ml) at baseline and who had no more than one previous chemotherapy regimen, were included. CEA levels were measured after two treatment cycles of platinum based chemotherapy (75%) or a tyrosine kinase inhibitor (25%). We evaluate the change in serum CEA levels and the association with response measured by RECIST criteria.Results
After two chemotherapy cycles, the patients who achieved an objective response (OR, 30.2%) had a reduction of CEA levels of 97% compared to its basal level. Patients that achieved a decrease in CEA levels> =20% presented and overall response in 72% of cases, stable disease in 26% and progression in 2%. Patients with stable disease and progression have an increase of CEA levels of 12% and 90% from baseline, respectively (p < 0.001).Conclusion
A reduction of serum CEA level (20%) from baseline after 2 cycles of treatment in advanced NSCLC is an accurate measurement of OR. The comparison de CEA levels (Before and after chemotherapy) in NSCLC is associated with objective response by RECIST and should be part of the routine follow-up of advanced NSCLC patients.
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P2.11 - Poster Session 2 - NSCLC Novel Therapies (ID 209)
- Event: WCLC 2013
- Type: Poster Session
- Track: Medical Oncology
- Presentations: 1
- Moderators:
- Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P2.11-048 - Nutritional status, body surface and sarcopenia are associated to dose reduction and severe gastrointestinal toxicity related to afatinib in patients with advanced NSCLC (ID 3482)
09:30 - 09:30 | Author(s): D.O. Cortez
- Abstract
Background
Afatinib, an irreversible tyrosine kinase inhibitor of ErbB-family, has shown clinical benefits and prolonged progression free survival in EGFR mutated patients. Adverse effects related to afatinib such as diarrhea, stomatitis and rash can negatively impact on QoL and survival by interrupting treatment. Dose of TKI´s of EGFR are fixed regardless of weight or body surface (BS), which could affect the severity of treatment related toxicity.Methods
We prospectively studied patients with advanced Non-small cell lung cancer (NSCLC ) treated with afatinib in order to determine if malnutrition and clinical factors are associated to higher incidence of severe toxicity. This study was approved by Ethics and Investigation Committees Prior treatment with afatinib (40mg), 84 patients was assessed. Nutritional status was assessed by Subjective Global Assessment (SGA) and muscle volume was determined by CT scan analysis using L3 as anatomic landmark (-29 +150 HU). Toxicity was obtained during 2 cycles by CTCAE 4.0, severe toxicity is defined as grades 3 and 4.Results
Mean age was 59.3±14.8 years, 70.2% were women, 94% had adenocarcinoma, 91.7% had a good performance status (ECOG 0-1). Median weight and BS were 59.8±13.4 kg and 1.6±0.21 m[2]). Afatinib was indicated as 2[nd], 3[rd] and 4[th] line of treatment in 54.8%, 38.1%, and 7.12% of patients, respectively. Sixty percent of patients had some grade of malnutrition (SGA B+C). Severe diarrhea, mucositis and overall GI toxicity were present in 38.9%, 28.8% and 57.5% respectively. Fifty percent of patients required dose reduction, only 6 patients presented severe diarrhea and mucositis simultaneously with no statistical association (p=0.929). Factors associated to severe diarrhea, mucositis, overall gastrointestinal toxicity and dose reduction are shown in Table 1. Table 1 Related factors to Afatinib toxicity.
GI: Gastrointestinal. SGA : Subjective Global Assessment. ECOG: Eastern Cooperative Oncology Group Performance Scale.Diarrhea G3/4 (%) Mucositis G3/4 (%) All GI toxicity G3/4 (%) Dose reduction % Female Male p 44.4 22.2 p=0.094 33.3 15.8 p=0.146 64.8 36.8 p=0.034 59.3 36.8 p=0.092 ECOG 0-1 >1 P 36.9 57.1 p=0.419 24.2 71.4 p=0.018 53.1 100 p=0.017 53.0 57.1 p=0.836 BMI ≤18.5 >18.5 P 47.1 31.6 p=0.179 38.5 17.6 p=0.05 55.9 59 p=0.79 50 56.4 p=0.584 Body surface ≤1.7m[2 ] >1.7m[2 ] p 40.7 33.3 p=0.572 0 38.9 p=0.001 36.8 64.8 p=0.0034 36.8 59.3 p=0.092 Malnutrition SGA A SGA B+C p 36.3 29 p=0.136 16.1 38.1 p=0.04 38.7 71.4 p=0.005 32.3 69 p=0.002 Hemoglobin(mg/dl) <12mg/dl >12mg/dl p 68.8 30.4 p=0.005 28.1 31.2 p=0.804 50.9 81.2 p=0.03 47.4 75 p=0.05 Conclusion
The performance status, malnutrition and body surface are independent factors related to severe gastrointestinal toxicity to Afatinib. The only independent factor associated with dose reduction was malnutrition. This study suggests that for the initial dose selection of TKI´s of the EGFR these factors should be considered in order to reduce the risk of severe toxicity.
