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A. Linhas



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    P1.01 - Poster Session with Presenters Present (ID 453)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Epidemiology/Tobacco Control and Cessation/Prevention
    • Presentations: 1
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      P1.01-023 - Smoking Cessation before Initiation of Chemotherapy in Metastatic Non-Small Lung Cancer: Influence on Prognosis (ID 5610)

      14:30 - 14:30  |  Author(s): A. Linhas

      • Abstract

      Background:
      The association between cigarette smoking and lung cancer mortality is well known. Some studies have shown a decreased overall survival (OS) in early stage non-small cell carcinoma (NSCLC) patients that continue to smoke after diagnosis. It is documented that in patients with metastatic disease, continued smoking increases resistance to systemic therapies but the impact of smoking cessation during treatment on outcomes for these patients is not well defined. Objective: To evaluate the impact of smoking cessation, before initiation of chemotherapy (CT), on survival in advanced NSCLC.

      Methods:
      Patients referred to our centre, between January 2010 and June 2016, and diagnosed with metastatic NSCLC were analysed. Patients defined as smokers at diagnosis and treated with at least one cycle of chemotherapy were included. Clinical characteristics and survival outcome were reviewed and compared between patients who quit smoke before and after the initiation of chemotherapy.

      Results:
      A total of 113 patients were included [mean age 59±10 years; 89.4% (n=101)]. The histological type more predominant was adenocarcinoma (70.8%) and the most common sites of metastasis were lung, bone and brain (35.4%, 23.9% and 23%, respectively). The majority of patients had performance status 1 and no weight loss at time of diagnosis (53.1% and 58.4%, respectively) and the comorbidity most prevalent was hypertension (19.5%). The average number of cigarettes smoked was 51±23pack-years and 81.4% of patients smoked >30pack-years. The most used CT regimen was platinum combined with pemetrexed (63.7%). Patients who quit smoking before CT showed a better median OS although not statistical significant (8 vs. 7 months; p=0.478). This was also seen in heavy smokers ≥30 pack-years, with a median OS of 8 vs. 6.5 months (p=0.674). The multivariate analysis only showed an influence of type of CT on survival.

      Conclusion:
      Although not significant differences in OS between groups were observed in our sample, the median survival was better in patients that quit smoking before the initiation of CT, even in heavy smokers. Continued smoking after CT initiation is known to adversely affect treatment response and quality of life and efforts to encourage smoking cessation even among this population of patients should be made.

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    P1.04 - Poster Session with Presenters Present (ID 456)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Pulmonology
    • Presentations: 2
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      P1.04-026 - Coexisting Lung Cancer and Interstitial Lung Disease: A Challenge in Clinical Practice (ID 5611)

      14:30 - 14:30  |  Author(s): A. Linhas

      • Abstract

      Background:
      Lung cancer (LC) risk is increased in patients with interstitial lung disease (ILD), and the two diseases sometimes occur concomitantly. Cigarette smoking is a recognised risk factor for development of both pathologies but the aetiology and pathogenesis of LC in patients with ILD is still unclear. The benefit of chemotherapy or radiotherapy for LC in cases of ILD remains unknown. Objective: To analyse characteristics and outcomes of patients with ILD and LC.

      Methods:
      A retrospective analysis of all patients presenting with concomitant ILD and lung cancer to our centre, between 1[st] January 2011 and 30[th] June 2016, was performed. Diagnosed lung cancer patients with suspected ILD, but not confirmed, were excluded, as well as patients who developed ILD in the setting of lung cancer therapy. Clinical, radiological and pathological characteristics of this cohort were described. Outcomes were also reported.

      Results:
      Eleven patients were included (mean age 63±12years). Most patients were men (82%) and heavy smokers (64% had a smoking history >30pack/year). The majority ILD cases were related to connective tissue disease (45%) and combined pulmonary fibrosis and emphysema (CPFE) (18%). The most prevalent lung cancer histological type was adenocarcinoma (45%); most patients were diagnosed at advanced stages (63%) and mainly during the clinical and radiological follow-up for the fibrosis. The mean time from the onset of ILD to the onset of LC was 39.4 months. On chest CT, the tumours were predominantly peripheral. Surgical resection was performed in 3 patients with stage I or II LC; chemotherapy and/or radiotherapy were given to 6 patients with advanced disease (stage III and IV). One patient was refused for radiotherapy due to considerations of the adverse effects on the prognosis. The median survival since the diagnosis of LC was 6.7months. Two patients died of respiratory failure due to progression of pneumonitis after the therapy and three patients died due to progression of LC.

      Conclusion:
      Patients with LC and ILD might benefit from chemotherapy and radiotherapy, but pre-existing ILD could influence negatively the prognosis. Therapy for LC should be considered in patients presenting both LC and ILD and interdisciplinary evaluation of therapeutic options is mandatory. When planning radiotherapy it is important determinate the radiation pneumonitis risk. More studies are needed to clarify the role of LC treatment in the management of ILD patients.

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      P1.04-027 - Changes in Pulmonary Function in Lung Cancer Patients after Thoracic Surgery (ID 5619)

      14:30 - 14:30  |  Author(s): A. Linhas

      • Abstract

      Background:
      Surgery is considered the first line treatment for patients with resectable early non-small cell lung cancer (NSCLC). Many of these patients present limited lung function which is caused by a common etiologic factor - cigarette smoking. The evaluation of pulmonary function preoperatively is important to identify candidates at risk of postoperative respiratory complications and may assist in operability decision. However, lung function after surgical resection may be affected by several factors. Objective: To evaluate changes in pulmonary function after thoracic surgery, in patients with solitary nodules or lung cancer.

      Methods:
      Retrospective study of patients diagnosed with operable lung cancer and solitary nodules followed in our centre between 1[st] January 2011 and 31[th] December 2014. Patients presenting pulmonary function tests (PFTs) until one year after surgery were included. Patients without PFTs after surgery were excluded.

      Results:
      Forty three patients were included. The results are presented in the table:

      Mean age 62±9 years
      Gender 67,4% (n=29) male
      Indications for surgery Adenocarcinoma Carcinoid tumour Squamous cell carcinoma Solitary pulmonary nodule 44,2%(n=19) 14%(n=6) 11,6% (n=5) 25,6% (n=11)
      Clinical staging in lung cancer patients IA IB IIA IIIA 43,7% (n=14) 15,6% (n=5) 12,5% (n=4) 18,7% (n=6)
      Location of the lesion Superior right lobe Superior left lobe 34,9% (n=15) 25,6% (n=11)
      Neoadjuvant chemotherapy Neoadjuvant radiotherapy 20,9% (n=9) 4,7 (n=2)
      Open surgery Video-assisted thoracic surgery (VATS) 83,7% (n=36) 16,3%(n=7)
      Comorbidities Chronic Obstructive Pulmonary Disease (COPD) Ischemic Heart Disease (IHD) 30,3% (n=13) 4,7% (n=2)
      Smoking habits Smoker Ex-smoker Non-smoker 37,2% (n=16) 32,6% (n=14) 30,2% (n=13)
      The mean values of FVC (L), FEV1 (L), FEV1/FVC and DLCO decreased after surgery (p=0.010, p=0.001, p=0.011 and p=0.037, respectively). FVC (L) and FVC (%) values decreased more significantly in patients submitted to pneumonectomy (p=0.004 and p=0,047). There was, though, an improvement of FVC (%) in patients submitted to VATS and wedge resection (p=0.005 and p=0.034). FEV1 (L) mean values increased in patients submitted to wedge resection (p=0.017) and decreased in patients submitted to pneumonectomy (p=0.04). There was no significant association between histological type, clinical stage, local of the lesion, COPD and CVD and lung function parameters before and after surgery.

      Conclusion:
      The postoperative pulmonary function varied according to the type of surgery, therefore the surgical procedure adopted may help us predict changes in lung function after lung surgery. Clinicians should be aware of these changes when determining the surgical method, especially in high-risk patients.

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    P2.02 - Poster Session with Presenters Present (ID 462)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Locally Advanced NSCLC
    • Presentations: 1
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      P2.02-018 - Chemoradiotherapy in Elderly Patients with Locally Advanced Non-Small Cell Lung Cancer (ID 5607)

      14:30 - 14:30  |  Author(s): A. Linhas

      • Abstract

      Background:
      The incidence of lung cancer increases with age and approximately 50% of non-small cell lung cancer (NSCLC) patients are over 70 years old. Combined modality therapy is standard of care for patients with unresectable locally advanced non-small cell lung cancer (NSCLC), however, despite the multitude of clinical trials performed, elderly patients have been under-represented in these studies. Objective: To investigate outcomes for elderly patients treated with chemoradiotherapy (CRT).

      Methods:
      Patients with locally advanced stage NSCLC admitted in a tertiary hospital, between 1th January 2014 and 31th may 2016, who received CRT were selected. Patients were divided in two groups by age (<70 vs. ≥70-years old). Clinical-demographic variables, overall survival (OS) and progression free survival (PFS) were compared between the two groups.

      Results:
      Fifty-one patients were included. The results are presented in the table:

      <70years n=23(45,1%) ≥70years n=28(54,9%) p
      Gender
      Male[n;(%)] 19(82.6) 26(92.9) 0.390
      Performance status (at diagnosis)[n;(%)]
      0 6(26.1) 10(35.7) 0.172
      1 16(69.6) 13(46.4)
      2 1(4.3) 5(17.9)
      Weight loss (at diagnosis)[n;(%)]
      0% 14(60.9) 16(57.1) 0.895
      5% 6(26.1) 7(25.0)
      10% 3(13.0) 5(17.9)
      Clinical stage[n;(%)]
      IIIA 10(43.5) 17(60.7) 0.070
      IIIB 13(56.5) 11(39.3)
      Comorbidities[n;(%)]
      Heart failure - 4(14.8) 0.076
      Hypertension 7(30.4) 20(74.1) 0.002
      Dyslipidemia 5(21.7) 12(44.4) 0.091
      Chemotherapy regimen[n;(%)]
      Carboplatin 5(21.7) 20(71.4) 0.146
      Cisplatin 18(78.3) 8(28.6)
      CRT[n;(%)]
      Sequential 6(26.1) 11(39.3) 0.320
      Concurrent 17(73.9) 17(60.7)
      Second line treatment[n;(%)]
      No 16(69.6) 21(75.0) 0.320
      Yes 7(30.4) 7(25.0)
      Comparing with younger group the elderly group presented significant worse OS and longer PFS, although without statistical significance [respectively, median 7 vs. 12months (p=0.006) and median 11.5 vs. 8months (p=0.687)]. Elderly patients with higher PS presented worse survival (p=0.045). Patients submitted to a chemotherapy regimen with cisplatin presented better OS and PFS in both groups, although only statistical significant for the OS in patients under 70 years (p=0.023). There was no influence of other variables on OS and PFS.

      Conclusion:
      In our sample age was an important prognostic factor in patients submitted to CRT but other factors, as PS, also can influence prognosis. In both groups patients treated with cisplatin presented superior OS but less patients above 70 years received this treatment. Elderly patients could be considered for CRT treatment but each case should be analysed individually. More studies are needed to guide treatment in this population.

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    P3.02c - Poster Session with Presenters Present (ID 472)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P3.02c-043 - Immunotherapy in Non-Small Cell Lung Cancer: A New Approach and a New Challenge (ID 5614)

      14:30 - 14:30  |  Author(s): A. Linhas

      • Abstract

      Background:
      Effective options are limited for patients with non-small cell lung cancer (NSCLC) with progressive disease after first-line chemotherapy. In these patients, immune checkpoint modulators have recently proven to be successful targets, being nivolumab the first immune checkpoint inhibitor approved for NSCLC. In contrast to conventional chemotherapy, these agents appear to have potential for effecting durable responses and possibly long-term survival. Immune checkpoint inhibitors generate atypical types of tumour responses and have a specific toxicity profile which is challenging current practices. Objective: To investigate outcomes and adverse effects in patients treated with nivolumab.

      Methods:
      Stage IV NSCLC patients treated with nivolumab at our centre between 30th September 2015 and 30th June 2016 were retrospectively analysed. We describe clinical features, toxicity and outcomes in these patients.

      Results:
      Fifteen patients were included [mean age 62±8 years; mainly male (n=12)]. Almost all patients had a history of tobacco smoking (n=12; mean pack/year45). The observed histological type were adenocarcinoma (n=10) and squamous cell carcinoma (n=5). All patients received prior systemic therapy, mainly platinum based regimens. At time of the initiation of nivolumab most patients had an ECOG performance-status score of 1 (n=12) and stage IV cancer (n=10). Only one patient received subsequent cancer therapy and the remaining alive patients at time of the study was still under nivolumab treatment. Mean duration of treatment was 3.5months (median of 4 cycles). The median survival since the beginning of nivolumab was 2.3months (min 7days; max 8.7months). Treatment-related adverse events of grade 1 or 2 were reported in 20% of the patients: thyroid hormone alterations were present in 3 patients and 2 needed thyroid hormone replacement; 1 patient presented immune related eczema and another suspected myocarditis. Two patients suspended nivolumab temporarily and two patients died.

      Conclusion:
      Besides the efficacy profile of immune targeted agents it is important to be aware of possible immune-related adverse events. These toxicities remain largely unknown and will be more frequent in routine practice as the number of patients treated with nivolumab increases. Although severe adverse effects remain rare, they can become life-threatening if not anticipated and managed appropriately. Ongoing evaluation is needed to define the most appropriate timing and patient population that will benefit from therapy with an immune checkpoint inhibitors and to learn how to deal with its adverse effects.