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B. Čučević



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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): B. Čučević

      • 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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    P1.07 - Poster Session with Presenters Present (ID 459)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: SCLC/Neuroendocrine Tumors
    • Presentations: 1
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      P1.07-013 - Treatment Related Side Effects of Oral Topotecan in Small Cell Lung Cancer (ID 5000)

      14:30 - 14:30  |  Author(s): B. Čučević

      • Abstract

      Background:
      Lung cancer is the most common tumor in men and the second most common tumor in woman according to the latest data available from the Croatian National Cancer Registry. Approximately 20% of all lung cancers are categorized as small cell lung cancer (SCLC). Topotecan is recommended as second-line chemotherapy in treatment of SCLC. Topotecan can be administrated orally with the same effectiveness as parenteral.

      Methods:
      The aim of this study was to determine toxicity of oral topotecan in second line of chemotherapy and to establish the frequency of drug related admissions.

      Results:
      A total of 177 courses of therapy were administered to the 64 patients, 17 woman and 47 men, with SCLC patients ranging from 42 to 77 years with the mean age of 59.3. All the patients were treated in University Hospital Centre Zagreb from January 2012 to October 2015. Included patients had ECOG performance status of 0 or 1. Topotecan was administrated every 21 day, at the dose of 2.3 mg/m[2]/day, during 5 days. Average number of courses received was 2.8. Of all included patients 17 of them (26.5%) were admitted to hospital because of adverse events related to topotecan administration. The majority of patient hospitalizations (11 patients, 16.9%) was due to febrile neutropenia. Other reasons for hospitalization were severe diarrhea in 4 patients (6.2%), pneumonia in 1 patient (1.5%) and severe electrolyte imbalance in 1 patient (1.5%). Of 17 admissions to hospital 10 (58.9%) of them were after application of first chemotherapy cycle, 3 (17.6%) after second cycle and 4 (23.5%) after third cycle. Quantitative hematologic toxicities were assessed using the National Cancer Institute Common Toxicity Criteria. Anemia grade 3 or 4 occurred in 13 patients (20.3%). Grade 3 or 4 thrombocytpenia occurred in 7 patients (10.9%). Grade 3 or 4 neutropenia occurred in 16 patients (25%). Of other, non-hematologic adverse effects the most serious was grade 3 or 4 diarrhea that occurred in 5 patients (7.8%).

      Conclusion:
      although admission of oral topotecan is well tolerated it is related with high rate of hospitalizations due to myelotoxicity and gastrointestinal toxicity during therapy.

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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): B. Čučević

      • 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): B. Čučević

      • 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.