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M. De La Torre-Vallejo
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MINI 29 - Meta Analyses and Trial Conduct (ID 156)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:D. Morgensztern, M. Redman
- Coordinates: 9/09/2015, 18:30 - 20:00, Mile High Ballroom 2a-3b
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MINI29.04 - The Use of Metformin and Proper Glycemic Control Are Associated with Improved Survival in Non-Small Cell Lung Cancer Patients (ID 1612)
18:45 - 18:50 | Author(s): M. De La Torre-Vallejo
- Abstract
- Presentation
Background:
Previous population-based studies have shown an association between metformin use and improved survival among diabetic patients with lung cancer. We sought to analyze the effect of diabetes and its treatment in terms of survival in Mexican patients with lung cancer treated at a single institution
Methods:
1106 patients were included. Outcomes were compared between patients with (n=186) and without diabetes (n=920). Characteristics associated with antidiabetic treatment and with proper glycemic control (defined as mean plasma glucose <130mg/dL) were examined. Overall survival (OS) among the different patient populations was analyzed using Kaplan-Meier curves and multivariate analysis was used to determine the influence of patient and tumor characteristics on survival
Results:
OS for the entire population was 18.3 months (95% CI 16.1-20.4). There was no difference in OS between diabetic and non-diabetic patients (18.5 vs 16.4 months, p = 0.62). Diabetic patients taking metformin had a superior OS than those taking other antidiabetic treatment (25.6 vs 13.2 months, p = 0.001), and those with proper glycemic control had a better OS than those without proper glycemic control (40.5 vs 13.2 months, p<0.001). Both the use of metformin (HR 0.57 p = 0.017) and proper glycemic control (HR 0.40, p =0.002) were significant protective factors in the diabetic patient population.
Conclusion:
Proper glycemic control and metformin use have a beneficial effect on the survival of patients with diabetes and lung cancer. Studies using metformin in lung cancer should include measures of proper glycemic control as fundamental variables.
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ORAL 29 - MASCC-IASLC Joint Session: Palliative and Supportive Care (ID 136)
- Event: WCLC 2015
- Type: Oral Session
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:A. Molasiotis, P. Van Houtte
- Coordinates: 9/08/2015, 16:45 - 18:15, 708+710+712
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ORAL29.06 - Skeletal Muscle and Lean Body Mass Loss Are Associated with Poorer Prognosis in Patients with NSCLC Treated with Afatinib (ID 3053)
17:39 - 17:50 | Author(s): M. De La Torre-Vallejo
- Abstract
- Presentation
Background:
Irreversible tyrosine kinase inhibitors of the epidermal growth factor receptor (EGFR) such as afatinib have shown clinical benefits and prolonged survival in patients with NSCLC. Weight loss and sarcopenia are common in NSCLC patients and have been recognized as important prognostic factors of toxicity and survival. The aim of this study was to assess the impact of muscle and
Methods:
Patients diagnosed with NSCLC, who progressed to prior chemotherapy, received 40 mg of afatinib. Skeletal muscle (SM) was quantified by computed tomography scan analysis using pre-established Hounsfield (HU) unit threshold and lean body mass (LBM) was calculated with the following formula: LBM (kg)=(0.30 × (skeletal muscle area at L3 using CT (cm[2]))+6.06). These variables were estimated at baseline (T0) and after four months of treatment with afatinib (T1).
Results:
Eighty-four patients were assessed at baseline. 70.2% were female, mean age was 59.3±1.6 years, 94% had adenocarcinoma, 53.6% received afatinib as 2nd line of treatment, and 91.7% had a good performance status (ECOG 0-1). Patients included were both EGFR+ (23.8%) and EGFR- (76%). Body composition evaluation was obtained at T0 and T1 in 46 patients, median differences (∆) between T0 and T1 for SM, LBM and weight were -1.4(-56.8, +27.9 cm[2]), -0.42(-17,-8 kg) and -0.1(-12,+6), respectively, and were not statistically significant. Median OS and PFS were 23.8(17.9-29.7) months and 8.9(5.5-12.4) months, respectively (including EGFR+ and EGFR-). Weight loss was not statistically associated with poorer OS or PFS. However, SM and LBM loss greater that the median had a negative impact on PFS and OS. Figure 1(Figure1).
Conclusion:
SM and LBM changes throughout treatment with EGFR TKIs should be evaluated. Nutritional interventions should be focused on the maintenance of SM and LBM. Further clinical trials should focus on interventions improving these body composition variables since they are associated with better OS and PFS in patients with NSCLC treated with afatinib.
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P1.11 - Poster Session/ Palliative and Supportive Care (ID 229)
- Event: WCLC 2015
- Type: Poster
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.11-006 - Association between Nutritional Status Variables and Fatigue Diagnosis in Patients with Non Small Cells Lung Cancer (ID 3013)
09:30 - 09:30 | Author(s): M. De La Torre-Vallejo
- Abstract
Background:
Cancer-related fatigue (CRF) is a common and persistent symptom experienced by patients with Non Small Cells Lung Cancer (NSCLC). It is produced by multifactorial factors including those associated to the disease itself, comorbidities, life style and/or treatment. Malnutrition is found in up to 80% of patients with advanced cancer and could be associated with the presence of CRF. Both, malnutrition and fatigue have a negative impact on many aspects of patients’ Health-related quality of life, treatment compliance and prognosis. The aim of this study was to associate nutritional status variables with the occurrence of CRF in patients with advanced NSCLC.
Methods:
Patients with advance stage NSCLC under different lines of treatment were prospectively evaluated. Fatigue was assessed by the FA-13 (EORTC) test; malnutrition and anorexia were diagnosed using Subjective Global Assessment (SGA) and (S/AC-12) FAACT, respectively. Weight loss in the last six months was calculated, albumin and hemoglobin levels were used as biochemical parameters of nutrition.
Results:
129 patients were included, 75 were female (58%), the mean age was 61.9±13.8 years, Adenocarcinoma histology was present in 92 patients (71.4%) and the rest were classified as other histology, 90 patients (69.8%) were in ≤2[nd ]line of treatment, 106 patients (83.5%) had a functional status between 0-1 and the rest between 2-3, according to SGA 79 patients (64.8%) had any grade of malnutrition, 94 patients (75.8%) had a weight loss ≥10kg in six months, 25 patients (19.4%) were diagnosed with anorexia, albumin mean was 3.8mg/dl and 55 patients (32%) had less than that, as well as Hemoglobin level mean was 12.7 mg/dl and 61 patients (35.5%) had a valor less than it. Nutritional variables associated with CRF are shown in Table 2. Nutritional variables as Malnutrition, weight loss ≥10% and albumin were related with higher presence of physical, emotional, cognitive and daily-life fatigue. Clinical variables as histology, line of treatment and functional status were analyzed and just poor functional status was associated with higher presence of physical, emotional, cognitive and daily-life fatigue (p≤0.01). Table 2.- Nutritional status variables related fatigue
FS: fatigue scoren=129 Physic-FS p Emotional-FS p Cognitive-FS p Daily-life-FS p Social-FS p Nutritional-Status Malnourished Wellnourished 42 25 <0.01 42 25 <0.01 42 25 0.001 33 33 0.001 0 0.224 Weight-loss (≥10% 6 months) ≥10 <10 50 33 0.003 50 33 0.001 42 25 0.002 67 33 0.006 0 0.273 Anorexia Yes No 67 33 <0.01 58 33 <0.01 58 25 <0.01 67 33 <0.01 33 0 0.02 Albumin-(gr/dL) <3.8 ≥3.8 42 33 0.004 42 25 0.003 42 25 0.004 33 33 0.002 0 0.212 Hemoglobin-(gr/dL) <12.7 ≥12.7 42 33 0.077 42 25 0.04 42 25 0.012 33 33 0.227 0 0.023
Conclusion:
Malnutrition, weight loss, anorexia, hypoalbuminemia and low hemoglobin are associated with CRF. Hence, timely nutritional evaluation should be considered in NSCLC patients. Early nutritional treatment could help to reduce treatment and disease related fatigue. Nutritional and psychological support might confer beneficial effects.
