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O. Caffo



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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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      P2.10-025 - Weekly paclitaxel (wPCT) for pre-treated patients (pts) with advanced non-small cell lung cancer (aNSCLC): a single institution experience in the daily clinical practice. (ID 1527)

      09:30 - 09:30  |  Author(s): O. Caffo

      • Abstract

      Background
      Pemetrexed and docetaxel represent the reference treatments as second line chemotherapy for pts with aNSCLC after failure of a platinum-based treatment, with a response rate (RR) < 10%. However, non-squamous aNSCLC pts could have received pemetrexed into the first line setting and docetaxel may present a relevant side effects burden, in both 3-week and weekly schedules. wPCT is a well tolerated drug which proved to be active in aNSCLC. In the attempt to improve pts compliance we adopted wPCT in the daily practice.

      Methods
      From January, 2010, all pts with aNSCLC progressing after platinum-based chemotherapy and eligible for further chemotherapy received wPCT at 80 mg/sqm for 6 consecutive weeks, followed by a 2-week rest. In absence of clinical evidence of progressive disease at least two courses of wPCT were planned before instrumental re-staging. Responders pts continued the treatment up to a maximum of 4 courses.

      Results
      From January, 2010 to October 2012 a consecutive series of 43 pts was treated with wPCT. The median age was 62 yrs (range 32-74); all but two presented metastatic disease at the diagnosis. Thirty-three, 5, and 5 pts received wPCT as second, third and fourth line treatment, respectively. Five pts received only 1 wPCT course, 30 pts 2 courses, 3 pts 3 courses, and 5 pts 4 courses, for a total number of 94 administered courses. wPCT was well tolerated: only 2 pts experienced a grade 3 toxicity (1 pt liver and 1 pt diarrhea). No toxicity-related treatment interruptions were recorded. Nine pts (21%) achieved a partial response and 9 a stable disease. After a median follow-up of 9 mos, the median PFS and OS were 4 and 11 mos, respectively. The 1-y OS was 30.2%.

      Conclusion
      From our experience wPCT in daily clinical practice may represent a reasonable chemotherapeutic option for pre-treated aNSCLC pts, with a manageable toxicity profile, and may provide disease control rates comparable to those of docetaxel and pemetrexed.

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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
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      P2.11-023 - BE-Positive: Gefitinib in first-line treatment of advanced non-small cell lung cancer (NSCLC) patients harboring activating epidermal growth factor receptor (EGFR) mutations. A combined retrospective and prospective analysis from Italian patients. (ID 1881)

      09:30 - 09:30  |  Author(s): O. Caffo

      • Abstract

      Background
      Advanced NSCLC patients have an extremely poor prognosis with a 5-year survival rate of less than 5%. In 2009, the European Medicines Agency approved gefitinib, a reversible EGFR tyrosine kinase inhibitor, at the dose of 250 mg daily for the treatment of adult patients with locally advanced or metastatic NSCLC with EGFR activating mutations. As the first-line EGFR mutation positive data at that time were mainly in Asian populations a prospective phase IV, open-label, single-arm study of first-line gefitinib in Caucasian patients was presented: this trial confirmed the activity and efficacy of gefitinib in 106 Caucasian patients (Douillard EMCTO 2013). In the same way, we initially collected retrospectively, continuing then prospectively, the data of NSCLC EGFR-mutation positive Italian patients treated with first-line gefitinib, with the aim to evaluate the therapeutic outcomes and the approaches beyond progression in a “real life population”.

      Methods
      We collected data of patients who started gefitinib from June 2009 until May 2013. Primary endpoint was the evaluation of first line outcomes, in terms of: objective response rate (ORR), duration of treatment, progression-free survival (PFS), overall survival (OS) and safety. Secondary endpoint is the evaluation of the outcomes beyond progression to gefitinib. Here we report the results of first-line gefitinib of a large number of Caucasian patients.

      Results
      Data of 203 patients from 23 Italian Institutions were collected. The main patients characteristics were: median age 67 (range: 33-87), male/female 76/127, ECOG performance status (PS) 0/1/2/3/4 in 89/92/18/2/2 patients, 90.6% adenocarcinoma (in our study the percentage of carcinoma non otherwise specified was 1.5%), never/former/current smoker in 129/64/10, del19/L858R/uncommon in 128/57/18. In one case a T790M mutation ex novo was found in association with the deletion of the exon 19 (not all the patients were tested for this mutation at baseline). A median time for obtaining the EGFR test result was 8-15 days (more than 30% of the patients got the results in less than one week). Patients evaluable at the time of data lock were 168, of these 3 (1.8%) patients achieved a complete response, 72 (42.9%) a partial response for an ORR of 44.7%, 54 (32.1%) patients were stable. Median treatment with gefitinib was 38 weeks. Main toxicities were: grade 3-4 skin rash and diarrhea in 1.8% and 4.2%, respectively. Treatment was definitely stopped due toxicity in 4.2% of patients. After progression in 5 cases a re-biopsy was performed and 94 (56%) received a second-line treatment.

      Conclusion
      BE-Positive is the first study reporting results of first-line gefitinib in a large "real life population" of Caucasian patients. Data were firstly collected in a retrospective fashion, than in a prospective way. This study shows that Caucasian patients reported lower ORR when indirectly compared to Asian counterparts, but this is probably due to the partial analysis of the patients, excluding at this time those who are still on treatment. However, the tolerability profile was excellent and the median time of treatment is quite overlapping to literature data. The outcomes of PFS, OS and treatment beyond gefitinib progression will be reported when mature.