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H.C. Freitas
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P2.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 234)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.04-033 - Patterns of <em>EGFR</em> Mutations in a Cohort of 395 Patients from a Single Institution in Brazil (ID 2954)
09:30 - 09:30 | Author(s): H.C. Freitas
- Abstract
Background:
Lung cancer is among the most common malignancies in Brazil. Nevertheless, so far, there are no official data on EGFR mutation frequency in the country, the test is not routinely offered in the public system and there seems to exist great disparities in patient access to EGFR testing across regions. In this study we describe the frequency and patterns of EGFR mutations from a single brazilian institution.
Methods:
DNA samples were obtained either by slide scraping or by laser microdissection of tumoral cells from paraffin embedded tissue blocks. Exons 18, 19, 20 and 21 of EGFR gene were tested for mutation by direct sequencing or by pyrosequencing using standard protocols. We used chi-square statistics, or Fisher’s exact test when appropriate, to compare proportions among groups.
Results:
From Aug/2010 to Jun/2014, 395 patients were tested for EGFR mutation at AC Camargo Cancer Center, Sao Paulo. Among tested patients, median age was 64y, 51% were female, 91% had adenocarcinoma, 27% were smokers/former smokers with median 12 pack year smoking history. The presence of EGFR mutations was associated with non-smoking status (p=0.023). Twenty six percent of patients (105/395) had EGFR mutations, 28.6% (30/105) of them were L858R, 42.9% (45/105) were exon 19 deletions and 28.6% (30/105) were composed of rare or complex mutations. Among patients with rare mutations, 56.6% (17/30) had more than one mutation detected. Rare/complex mutations were more frequently associated with non-adenocarcinoma histology (p=0.014), smoking history (p=0.03) and smoking intensity (p=0.02).
Conclusion:
In this cohort, the mutation frequency was higher than that reported in other western countries series. The high proportion of rare and complex mutations is also worthnoting and was more frequently seen in heavy smokers with non-adenocarcinoma histology.
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P2.11 - Poster Session/ Palliative and Supportive Care (ID 230)
- Event: WCLC 2015
- Type: Poster
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.11-007 - Geriatric Oncology and Lung Cancer: Comprehensive Geriatric Assessment (CGA) Aspects Related to Outcomes and Important End-Points (ID 492)
09:30 - 09:30 | Author(s): H.C. Freitas
- Abstract
Background:
Interdisciplinary oncology approach for geriatric patients (pts) is essential to improve health care, in the global era of populational aging. A possible way to implement that is to use CGA and interventions directed by its findings. Lung cancer (LC) treatment is a good scenario to present the importance of CGA, since its pts are usually old and with multiple comorbidities.
Methods:
LC pts with 70+ years old were found in our cohort of more than 600 pts, evaluated from Jan/12-Dez/12, the period of implementation of CGA in the Geriatric Oncology Unit of A. C. Camargo Cancer Center, a tertiary cancer care institution in Sao Paulo-SP, Brazil. Important geriatric data were extracted to evaluate those pts, to exemplify the importance of a coordinated interdisciplinary treatment plan with better chances of improving favorable clinical end-points. CGA assessments included scales of: activities of daily living/ADL (basic: Katz; instrumental: Lawton), mini-nutritional assessment, depression (geriatric depression scale/GDS), comorbidities and polypharmacy. Fit pts received mainly full treatment; frail/borderline pts, mainly modified tx and/or specific supportive care.
Results:
Eighty pts with LC were part of a subgroup of the major cohort. Most relevant data at first visit are show in the table below. All pts were assessed with CGA by at least one nurse, before medical oncology evaluation - sometimes, by a psychologist as well. Table 1. Relevant CGA data and elderly with lung cancer (n=80).
* Some subjects may have variable not available. In addition, selected comorbidity count ranged 0-5 (median 2); polipharmacy 0-6 (median 5). Seventeen pts were in follow-up only (21%); 48 (60%) pts were under chemotherapy (isolated or combined with other therapies). Even though CGA domains were altered in around 60% of them, the planned treatment could be offered to 57 (71%) pts. Longer survival probability, in the series, was predicted by performance status (ECOG), BADL (Katz) and mini-nutritional assessment.Variable Categories or values Age Median (range) 75 (70-88) n (%)* Sex Male/Female 44/36 55/45 ECOG/PS 0-1/2-3 53/23 63/29 Histology Adeno/SCC/Small cel 42/17/8 53/21/10 BADL KATZ = A 60 75 Altered KATZ 20 25 IADL Lawton = 27 27 34 Altered Lawton 53 60 GDS Normal (0-4) 43 54 Altered (≥4) 17 21 Not available (na) 20 25 Nutrition Undernourished ( < 8) 15 19 Under risk (8-11) 24 30 Normal (12-14) 24 30 na 17 21
Conclusion:
CGA is gaining increasing importance in geriatric oncology. In the present LC subgroup cohort, even though in a small case series, it shows that many pts are vulnerable or even frail; however, interdisciplinary evaluation and multimodal treatment could be offered, without major complications. Limitations include missing data in any domain of CGA, for example. All efforts to better study and define CGA and help to implement interdisciplinary interventions may be utile to improve elderly quality of life and survival in LC care.
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P3.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 208)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.01-019 - Treatment and Clinical Evolution of a Cohort of 105 EGFR Mutant Patients from a Single Institution (ID 3162)
09:30 - 09:30 | Author(s): H.C. Freitas
- Abstract
Background:
Lung cancer is among the most common malignancies in Brazil. The use of tyrosine-kinase inhibitors (TKI) is nowadays a solidIy stablished treatment strategy for EGFR mutaion bearing NSCLC metastatic tumors. In this study we describe the clinical evolution of a cohort of 115 EGFR-mutant NSCLC patients from a single brazilian institution.
Methods:
We describe a retrospective cohort of 115 consecutive patients bearing metastatic EGFR mutated NSCLC, treated at A.C.. Camargo Cancer Center, Sao Paulo, from August/2010 to December/2014. Patients were older than 18y and had to have a histologically confirmed NSCLC dianosis. Clinical and pathological data was extracted from their eletronical medical charts. Chi-square statistics, or Fisher’s exact test when appropriate, was used to compare proportions among groups, Kaplan-Meier method was used for survival analysis and log-rank’s test was performed to compare survival curves.
Results:
Median age was 64y, 62% of patients were female, 94% had adenocarcinoma and 22% were smokers/former smokers. Data about treatment and survival was available for 85/115 patients. Eighty eight percent (75/85) of them were metastatic at diagnosis, of whom 52% (39/75) received a TKI in first line, 24% (18/75) in second line, 5% (4/75) in third/later lines and 16% were never treated with a TKI. Median progression free survival (PFS) was 13.9 months (m) for first line TKI and 11.4m for TKI treatment in second line (p=0.028). Median PFS for first line platin-based chemotherapy was 9.6m as compared to 3.1m for platin-based chemotherapy in second line (p=0.001). PFS with TKI treatment was numerically superior but not statistically significant for patients bearing tumors with exon 19 deletions as compared to L858R mutantions (22.9m vs 13.4m, respectively; p=0.42). There was no difference in overal survival (OS) between patients treated with TKI in first or second line. Median OS for patients receiving first line TKI was 36.3m and was not reached for patients that received TKI in second line (p=0.61).
Conclusion:
OS survival was not different for patients bearing EGFR mutated NSCLC tumors treated in first or second line, despite a longer PFS for TKI given as first line therapy.
