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E. Quoix



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    MO19 - Lung Cancer Immunobiology (ID 91)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Biology
    • Presentations: 1
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      MO19.08 - DISCUSSANT (ID 3903)

      11:10 - 11:20  |  Author(s): E. Quoix

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    O18 - Cancer Control and Epidemiology II (ID 133)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      O18.04 - Impact of Passive Smoking on molecular pattern in Never Smokers with Non-Small Cell Lung Cancer: Findings from the BioCAST / IFCT-1002 Study (ID 3305)

      11:00 - 11:10  |  Author(s): E. Quoix

      • Abstract
      • Presentation
      • Slides

      Background
      EGFR and HER2 mutations are usually associated with never-smokers while KRAS and BRAF mutations are thought to be link with smoking behavior in Non-Small Cell Lung Cancer (NSCLC). Passive smoking exposure is a well-known risk factor for lung cancer. Only EGFR and KRAS mutations were investigated in association with passive smoking and showed conflicting results. We aimed to investigate mutation rate of EGFR, HER2, KRAS, BRAF and ALK in a cohort of never smokers regarding their passive smoke exposure.

      Methods
      The BioCAST / IFCT-1002 study is a prospective cohort of NSCLC patients diagnosed in French never-smokers patients (less than 100 cigarettes in lifetime) between November 2011 and January 2013, Passive smoking exposure was evaluated through standardized questionnaire. We obtained biomarkers mutation results through routine testing. We used Fisher, Chi-square, median test and Mann-Whitney U test for comparisons as appropriate. We used logistic regression to calculate adjusted odds ratio for risk of each mutations.

      Results
      Out of the 384 patients included in the BioCAST database, 334 (87.0%) had available data on passive smoking exposure. Among them, 219 patients (65.6%) were ever exposed to passive smoking in their lifetime. 198 (59.3%) reported a domestic exposure (122 during childhood at least) and 60 (18.0%) a workplace exposure. Result of at least one biomarker mutation was available in 313 patients (93.7%). including 128 EGFR mutations in 297 patients, 8/174 HER2 mutations, 18/256 KRAS mutations, 10/196 BRAF mutations, and 20/171 ALK gene rearrangements. We found no difference in mutation rate according to passive smoke exposure (cf. Table 1). There was no difference when comparing cumulative year of exposure, smoker-year or passive-pack year (as continuous variable) to the mutation rate, for any biomarker. When considered as categorical variable – after division in quartiles – we found also no difference. Results were similar when focusing on domestic (childhood versus adulthood included) and workplace exposure only. Finally, we found no significant increased risk for mutation for any biomarker in logistic regression adjusted for most of other lung cancer risk factors.

      EGFR Mt (n=297) HER2 Mt (n=171) KRAS Mt (n=256) BRAF Mt (n=196) ALK Fusion (n=171)
      % % % % %
      Overall exposure Never 46.5 3.5 6.7 5.9 13.0
      Ever 41.3 5.1 7.2 4.7 11.1
      Domestic exposure Never 45.8 2.9 7.7 6.4 11.1
      Ever 41.3 5.7 6.6 4.2 12.0
      Exposure at workplace Never 43.3 5.5 7.0 5.4 12.2
      Ever 42.3 0 7.0 3.6 8.3
      Total 43.1 4.6 7.0 5.1 11.7
      Exposure in childhood Ever 40.5 3.0 6.5 2.7 14.7
      Only in adulthood 42.6 10.3 6.8 6.7 7.5

      Conclusion
      Although we report the largest and more comprehensive study focusing on this topic, we found no significant difference in the biomarker mutation profile of NSCLC occurring in French never-smokers regarding their exposure to passive smoking as compared with the pattern of mutations described never-smoker patients with any passive smoking.

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    P1.11 - Poster Session 1 - NSCLC Novel Therapies (ID 208)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P1.11-047 - Management and outcome of Stage IV Non-small Cell Lung Cancer<br /> in a French department between 1998 and 2005 : the role of modern chemotherapy schemes and of the advent of targeted therapies (ID 3183)

      09:30 - 09:30  |  Author(s): E. Quoix

      • Abstract

      Background
      Platin-based doublets with a third generation drug are the mainstay of the treatment of fit patients with stage IV non-small cell lung cancer (NSCLC). However, the results reached a plateau at the beginning of the XXIst century with a median survival time of 8-9 months in the randomized trials. Since 2002, personnalized treatment was developed with histology-guided chemotherapy and targeted therapies with a median survival time around 12 months and even 21 months in some patients harboring mutations.

      Methods
      To ascertain the improvement in survival of patients with advanced NSCLC since the advent of new chemotherapies and targeted therapies, we conducted a retrospective population based-study on a sample of 1047 patients diagnosed with stage IIIb (wet) and IV primary NSCLC in a French department (Bas-Rhin) from 1998 to 2005.

      Results
      Median age at diagnosis was 65.0 years [26-92]. Patients aged > 70 represented 32.4% of the patients. The proportion of women increased throughout the period with an initial sex-ratio of 3.8/1 in 1998-2001 to 2.5/1 in 2002-2005. Thirteen % of the patients were never smokers. The proportion of adenocarcinomas increased significantly throughout the period at the expense of squamous cell carcinoma subtype. Best supportive care was the sole treatment for only 11.75% of the patients. The use of chemotherapy increased from 74.2% to 87.1% of the patients (p = 0.0021), and type of chemotherapeutic agents have evolved with a significant increased use of carboplatin (while there was a decreased use of cisplatine) and of drugs of third-generation. Among them, vinorelbine was the most frequently used at the beginning of the period (38.8 % versus1.75% paclitaxel whereas during the two last years, the proportions were respectively 18.9% and 22.7%. Use of targeted therapies (gefitinib and erlotinib) began in 2002 with 15% of the patients receiving these therapies in 2004-2005 essentially as 2nd, third or 4th line therapy (only 4 patients as 1st line). Overall survival was 6.5 months [CI 95% 5.8; 7.2]. There was a significant increase from 5.3 months [CI 95% 4.4; 7.2] in 1998-1999 to 7.3 months [CI 95% 6.1;8.6] in 2004-2005. In multivariate analysis of survival, female gender, adenocarcinoma histological subtype were significant independent favorable prognostic factors. Regarding treatment variables, platin-based doublets with third generation drugs, use of targeted therapies were both independent favorable prognostic factors with respective RR of 0.66 (CI95%=0.53; 0.84), and 0.30 (CI95%=0.22; 0.40).

      Conclusion
      In this population-based study we found the same epidemiological trends recently seen in France (increase in women proportion and of adenocarcinoma histological subtype). Never-smokers were a non negligible fraction of the patients. The introduction of modern chemotherapy schemes and targeted therapies explain probably the slight improvement in survival observed between 1998-1999 and 2004-2005 as in multivariate analysis there were significant independent favorable prognostic factors whreas peiods were not..

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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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      P1.24-039 - Outcome of a series of 25 consecutive patients aged 84 and more with stage IV NSCLC : an invitation to systemic treatment (ID 2827)

      09:30 - 09:30  |  Author(s): E. Quoix

      • Abstract

      Background
      Elderly patients and even more older elderly with stage IV NSCLC are often not optimally treated.

      Methods
      Not applicable

      Results
      Between april 1[st] 2010 and february 28th 2013, 25 patients ( aged 84 years or more were referred with a stage IV (11 M1a and 14 M1b) non-small cell lung cancer to our university hospital. There were 11 females and 14 males. There were 11 never-smokers. Median age was 87 years (range : 84-92). Histological subtypes were : 8 squamous cell carcinoma, 14 adenocarcinoma and 3 large cell carcinoma. Molecular analyses was performed in 17 cases among which 2 were impossible due to inappropriate biopsy specimen. EGFR- mutations were found in 4 female patients, 1 with exon 19 deletion and 3 with exon 21 point mutations. There were 3 K-RAS mutations and no ALK translocations. 6 patients received TKIs as first line treatment (5 gefitinib and 1 erlotinib). Two patients with no molecular analysis were treated with first-line TKI (both of them had PS 4, one died after 1.1 month, the other recovered very quickly and is still alive after 15.3 months). The other patients were treated with doublet carboplatine AUC 6 and weekly paclitaxel (90 mg/m², D1, 8, 15), with D1 = D29 (12 patients) or single agent therapy (paclitaxel (2), Gemcitabine (1), vinorelbine(1)). Three patients received only best supportive care (BSC). Doses of TKIs had to be lowered due to toxicity in 1 case. Median overall survival was 8.1 months with a one-year probability of survival of 46%. Survival of the 6 patients treated with first-line TKIs was 1.1, 3.1+, 6.43+, 14, 15.33+, 15.9+ months.

      Conclusion
      It must be noted that EGFR-mutations were more frequent compared to younger patients (at least 4/25) paralleling the high proportion of never-smokers (44%) and of female patients (44%). In this unselected consecutive series of older elderly patients, only 3 received BSC as sole treatment, while 4 were treated with single agent chemotherapy, 12 with a carboplatine-based doublet and 6 with TKIs as first line therapy, of which only 4 had proven EGF-R mutations. Survival was very similar to what is observed with younger counterparts and thus, nihilism is not appropriate in this category of patients.

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    PL04 - How Can We Stop the Epidemic of Lung Cancer? (ID 75)

    • Event: WCLC 2013
    • Type: Plenary Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      PL04.3 - A Critical Review of CT Lung Cancer Screening (ID 640)

      09:00 - 09:20  |  Author(s): E. Quoix

      • Abstract
      • Slides

      Abstract not provided

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