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A. Vassias



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    P1.17 - Poster Session 1 - Bronchoscopy, Endoscopy (ID 182)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Pulmonology + Endoscopy/Pulmonary
    • Presentations: 1
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      P1.17-002 - The clinical significance of endobronchial ultrasound in the detection of peripheral pulmonary lesions (ID 339)

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

      • Abstract

      Background
      Flexible fiberoptic bronchoscopy (FB) is the standard of care for the evaluation of pulmonary lesions. The aim of the current study is to investigate the effectiveness of EBUS-guided bronchoscopy compared to blind FB techniques in the study of non-visible pulmonary lesions.

      Methods
      We conducted a one year, retrospective, study comparing two populations: In the first one biopsies were performed conventionally (FB-B) with the help of static CT images and in the second biopsies were performed after EBUS- guidance (FB-EBUS). A 20- MHz radial- type ultrasound probe was used to obtain images. Sampling techniques, like bronchial brushing (BR) and transbronchial biopsies (TBB), were conducted in both populations by two separate bronchoscopists. If not a diagnosis was achieved a surgical biopsy or observation strategy was followed.

      Results
      Forty patients appeared with non visible lesions and were included in this study. Twenty patients were examined with the use of EBUS (FB- EBUS) and in twenty cases a conventional FB (FB-B) was conducted. Moreover left lower lobe was the most promising to obtain a diagnosis using ultrasonographic images.

      Conclusion
      Our results suggest that in patients with a non visible pulmonary lesion or SPNs a diagnostic strategy involving EBUS- guided biopsy techniques is a reasonable and effective choice.

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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. Vassias

      • 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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    P2.13 - Poster Session 2 - SCLC (ID 201)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P2.13-005 - Palonosetron (Aloxi®) effectively prevents nausea and emesis in SCLC patients receiving platinum-based three days regimen. (ID 2179)

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

      • Abstract

      Background
      We evaluated retrospectively the safety and effectiveness of single dose administration of palonosetron (Aloxi®) in SCLC patients receiving platinum-based three days regimen.

      Methods
      We retrospectively recorded the nausea and emesis of 417 SCLC patients (337 men and 80 women) with mean age 69.1 years (SD=9.0 years). Of those 63.3% had Extensive Disease (ED) and 36.7% Limited Disaese (LD). 318 pts (76.3%) received six cycles of chemotherapy and 229 pts (67%) received also radiotherapy, either concurrent or sequential. With regard to the chemotherapy regimen, 290 pts (69.5%) received Carboplatin (D1) & etoposide (D1-3), 99 pts (23.7%) received Carboplatin (D1), Irinotecan (D1) & etoposide(D1-3), and 28 pt (6.7%) received Cicplatin (D1) and etoposide (D1-3). The antiemetic treatment was i.v. administration of 0.25mg palonosetron on D1.

      Results
      315 (75.5%) of 417 patients didn’t experience any acute nausea and 329 (78.9%) patients remained free of nausea in the delayed phase . Free of vomit was 380 (91%) patients in the acute phase and 390 (93.5%) in the delayed phase. In compination 314 (75.3%) patients was free of vomit or nausea in the acute phase and 326 (78.2%) in the delayed phase with the use of palonosetron. No signs or symptoms due to toxicity from palonosetron observed in acute or delayed phase . Both univariate and multiple analyses indicated that the odds of nausea decreases as age increases and that woman had greater odds for nausea. No smoking related differences were recorded, but 94.8% of the patients were smoker. Addition of radiotherapy did not increase the probability of nausea or emesis and patients receiving cisplatin instead of carboplatin were more likely to experience nausea or emesis.

      Conclusion
      Our data indicate that single dose of palonosetron on D1 effectively controls acute and delayed nausea and emesis in SCLC patients receiving platinum based three days regimen.

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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. Vassias

      • 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.