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

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Pulmonology
    • Presentations: 1
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      P1.04-025 - The Impact of Emergency Presentation on Survival of Lung Cancer Patients (ID 5964)

      14:30 - 14:30  |  Author(s): L. Bitar

      • Abstract

      Background:
      A significant proportion of lung cancer patients are diagnosed through emergency department (ED), which is usually associated with poorer prognosis. We investigated the assocation between diagnosis of lung cancer after presentation through emergency department due to symptoms associated to lung cancer.

      Methods:
      Medical charts of patients with lung cancer patients newly diagnosed in Department for Respiratory Diseases Jordanovac, University Centre Zagreb in years 2012 and 2103 were reviewed. Overall survival was calculated and was compared between groups.

      Results:
      The medical charts of 951 males and 407 females, mean age 64 years (males 64.5, females 62) were reviewed. 292 out od 1359 patients (21,5%) were diagnosed with lung cancer after initial presentation through ED. The most common reasons for ED admissions were hemopytsis (in 31% of patients), pneumonia (16%), brain metastasis (15%), dyspnea (10%) and superior vena cava syndrome in 8% of patients. There were no differences in histology subptypes between two different routes of presentation (most common histology subtype was adenocarcinoma followed by squamous histology). Significantly higher proportion of patients diagnosed after initial diagnosis through ED were at presentation in stage IV (61 vs 44%, p<0.0001), poorer performance status (ECOG 3-4 vs ECOG 0-1, p<0.0001), significantly less patients underwent surgical resection (14 vs 5%, p<0.0001) and radiotherapy (56 vs 73%, p<0.0001). Median overall survival (mOS) was significantly lower in patients diagnosed through ED (6.0 vs 10.0 months, p<0.0001). In patients with non-small cell lung cancer (NSCLC) results were similar (mOS 6.0 vs 10.0 months, p<0.0001). In patients with small cell lung cancer (SCLC) mOS was also significantly worse (7.0 vs 9.0 months, p<0.0001) in patients diagnosed through ED.

      Conclusion:
      Higher stage, reduced access to surgical resection and radiotherapy, and significantly lower overall survival regardless of histology subtypes among lung cancer patients who presents through emergency department, stress out the importance of earlier diagnosis of lung cancer patients so that initial presentation through emergancy department can be reduced.

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    P1.05 - Poster Session with Presenters Present (ID 457)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 1
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      P1.05-077 - Outcome of N2 Disease in NSCLC - A Single Institution Experience (ID 5041)

      14:30 - 14:30  |  Author(s): L. Bitar

      • Abstract

      Background:
      There are many different therapy options available for stage IIIA-N2 NSCLC patients that were set by the NCCN guidelines. That is why we decided to evaluate outcome of different management strategies.

      Methods:
      Medical records of the patients diagnosed with lung cancer in Clinical hospital center Zagreb, Department for respiratory diseases Jordanovac during the year 2012 and 2013 were retrospectively collected and reviewed. Median overall survival (mOS) was measured and analyzed using the Kaplan-Meier and log-rank test.

      Results:
      There were 147 patients diagnosed with stage IIIA–N2 NSCLC, out of which 105 were male (71.4%), with median age 63 (40-102). Most of them were ex-smokers (54.4%), while only 9.5% never smoked cigarettes. Most of them had very good performance status at the time of diagnosis (ECOG 0-1 91.9%). 78 (53.1%) of the patients were diagnosed with adenocarcinoma, 62 (42.2%) with planocellular carcinoma, 6 (4.1%) with NSCLC-NOS and only 1 (0.7%) with adenosquamous carcinoma. mOS for all diagnosed lung cancer patients was 9 months and for NSCLC 8 months. mOS for IIIA-N2 NSCLC was 14 months. Our patients were treated with chemotherapy in 40.8% of the cases (mOS 11 months); sequential chemotherapy and irradiation in 25.2% (mOS 17 months); surgery, sequential chemotherapy and irradiation in 14.3% (mOS 26 months); surgery and adjuvant chemotherapy in 4.1% (mOS 15 months) and neoadjuvant chemotherapy and surgery in 1.4% (mOS 34 months) of the cases, while only 1.4% of all patients were treated with only surgical resection (mOS 4 months); (p=0.001).

      Conclusion:
      We analyzed the data collected at our department to assess the difference in outcomes of different strategies in IIIA – N2 management. The most of our patients were treated with platinum-based doublets only, followed by sequential chemotherapy and irradiation as a second most frequent therapy option. Only 21.8% of the patients were treated with surgery only or surgery combined with other forms of treatment. Only 1 patient underwent concurrent chemoradiation. The difference in overall survival between different therapy options showed highest mOS in patients treated with neoadjuvant chemotherapy and surgery followed by surgery and sequential chemotherapy and irradiation. Sequential chemotherapy and irradiation was superior to chemotherapy. The limitation of our study was a small number of patients in this specific subgroup, as well as small number of patients who underwent concurrent chemoradiation.

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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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      P2.02-051 - Prognostic Value of the Pretreatment Peripheral Blood Markers in Patients with Non-Small Cell Lung Cancer (ID 6120)

      14:30 - 14:30  |  Author(s): L. Bitar

      • Abstract

      Background:
      Lung cancer is the leading cause of cancer-related mortality worldwide. Regarding histological types, non-small cell lung cancer (NSCLC) represents 80% of all cases. In majority of all cases, NSCLC patients have locally advanced or metastatic disease at the time of diagnosis. Currently there is no predictive markers with clinical utility to guide treatment decisions in NSCLC patients undergoing therapy. We have compared mOS (median overall survival) before treatment (chemotherapy, radiotherapy or surgery) in patients with NSCLC regardless of the disease stage.

      Methods:
      Total of 1359 medical records of patients diagnosed with lung cancer Clinical hospital center Zagreb, Department of respiratory diseases Jordanovac during the year 2012 and 2013 were retrospectively collected and reviewed. Of that number, 1179 were NSCLC patients (all subtypes). We have analyzed normal and elevated biochemical markers: CRP (cut off value was 5.0 mg/L), leucocytes (cut of value was 10x10[9]/L), platelets (cut of value was 424x10[9]/L) and fibrinogen (cut off value was 4.1 g/L) in patients before treatment and calculated mOS (median overall survival). Since not all of 1179 patients performed pretreatment laboratory tests in our Department, we were unable to review laboratory findings of all diagnosed patients. mOS was measured and analyzed using the Kaplan-Meier and log-rank test.

      Results:
      We have found out that in case of elevated CRP and leukocytes values prior to treatment patients had lower mOS regardless of therapeutic modality. Additionally, elevated levels of fibrinogen and platelets do not affect mOS. From 1179 NSCLC patients, CRP was initially measured in 770. In 116 patients CRP was normal (<5mg/L) and in 654 elevated (>5mg/L). In patients with normal CRP mOS was 16 months, and in those with elevated CRP 10 months (p< 0.001). Leucocytes were initially measured in 842 patients. 444 patients had normal leucocyte values (<10 x10[9]/L) and 398 had elevated leucocytes (>10 x10[9]/L). Patients with normal leucocytes values had mOS of 13 months and those with elevated 10 months (p< 0.001).

      Conclusion:
      The prognostic impact of peripheral blood markers (CRP and leucocytes) supports the growing evidence of inflammation and cancer relationship. Elevated CRP and leucocytes before treatment are independent predictive factors for poorer mOS in NSCLC patients. The underlying mechanism by which these elevated markers affects the prognosis of lung cancer remains elusive.

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    P3.02b - Poster Session with Presenters Present (ID 494)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P3.02b-114 - Second Line Treatment of EGFR Positive Lung Adenocarcinoma - Our Experience (ID 6064)

      14:30 - 14:30  |  Author(s): L. Bitar

      • Abstract

      Background:
      EGFR testing and specific targeted therapy of lung adenocarcinoma is a standard worldwide. In Croatia, tirosin-kinase inhibitors (TKI)are allowed as a second-line therapy for EGFR positive (+) patients. We analysed the median overall survival (mOS) differences between TKI- and.conventional chemotherapy-treated patients as a second-line therapy.

      Methods:
      Medical records of patients diagnosed with lung adenocarcinoma and tested for specific mutations in Clinical hospital center Zagreb, Department for respiratory diseases Jordanovac, during the year 2013 and 2014, were retrospectively collected and reviewed. Median overall survival (mOS) was measured and analyzed using routine statistic tests.

      Results:
      A total of 334 patients were tested for EGFR mutations, 47 of whom came positive and 287 negative. There was signifficant difference between the two subgroups regarding some demographic categories: the majority (78,7%) of the EGFR + patients were female, as opposed to the EGFR - group. Also, the EGFR+ patients were older on average ath time of diagnosis.(66,04 vs 63,04 years). After recieving first line platinum based chemotherapy a total of 20 positive EGFR patients recieved second-line therapy. 15 were treated with TKI and 5 recieved pemetrexed. In the EGFR negative group, 100 patients received second-line therapy, 85 of whom recieved pemetrexed and the other 15 were treated with platinum- or gemcitabine- based chemotherapy. If analysing mOS of all the patients, there was statistically significant difference between the TKI-treated patients (mOS not met) compared to the other ones (mOS=20 months) (chi-square= 6,07; p=0,014). Also, if analysing only the EGFR positive patients, the mOS difference reached statistical significance, comparing the TKI-treated patients (mOS =24,3months) with those treated with pemetrexed. (mOS=15,7 months) (chi-square= 7,99; p=0,005)

      Conclusion:
      Our results showed the significance of molecular testing and specific TKI treatment of patients with EGFR positive lung adenocarcinoma, as they had a significatly better overall survival compared to patients treated with pemetrexed. The results are conclusive with the general experience and treatment recommendations, and should be implemented in every day praxis, i.e. enabling molecular testing and specific treatment for all EGFR+ patients, at least as a second-line therapy option, should be an imperative.