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M. Gianetta
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P1.06 - Poster Session with Presenters Present (ID 458)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.06-046 - Can We Better Manage Advanced NSCLC in the Elderly with the New Therapeutic Agents? Preliminary Analysis of a Real-Life Multicenter Study (ID 5814)
14:30 - 14:30 | Author(s): M. Gianetta
- Abstract
Background:
Systemic treatment of NSCLC has profoundly changed over the past years with novel therapeutic strategies recently implemented in clinical practice. Benefit of these novel agents in elderly patients (pts) is uncertain, given the paucity of prospective data in this population. Moreover, elderly pts are often undertreated, due to comorbidities and toxicity concerns. Therefore, we aimed to evaluate the access, safety and outcome with novel therapeutic agents in pts ≥ 70 years (yrs).
Methods:
We planned an observational study to retrospectively evaluate consecutive elderly patients (≥ 70 yrs) with metastatic NSCLC treated at 9 Italian Centers between January 2014 and December 2015. Data collected include clinical and pathological characteristics, treatment types, safety and outcome report.
Results:
220 patients with stage IV NSCLC were included in this preliminary analysis (53% IVa, 47% IVb). Median age was 74,5 (range 70-85) and 69% were male. 15% of pts aged 80 years or older. ECOG PS was 0, 1, 2 in 37%, 51% and 12% of pts, respectively. According to comprehensive geriatric assessment, 59% of pts were fit, 28% vulnerable and 13% frail. Histology was 23% squamous cell carcinoma, 72% non-squamous cell carcinoma and 5% NOS. EGFR mutation was diagnosed in 24% of cases; 1,4% and 1% of pts had ALK and ROS-1 translocations, respectively. 90% of pts received a systemic therapy: 48% a platinum doublet chemotherapy (CHT), 27% a mono-CHT, 25% an EGFR tyrosine kinase inhibitor (TKI). Only 1% of pts were treated with antiangiogenic drugs. Immunotherapy (IT) was administered in 16% of all treated pts. 7% of pts received only BSC. Second- and third-line treatment were given to 44% and 8% of pts, respectively. 51% of pts who received second line treatment and 60% of pts treated with a third line therapy had a novel therapeutic agent (II line TKI 20%, IT 31%; III line TKI 33%, IT 27%). 31% of pts were included in clinical trials. A dose reduction was reported in 41% of therapies and the discontinuation rate was 9%. Survival data are not mature at this time.
Conclusion:
Our data, albeit preliminary, suggest an evolution in the management of NSCLC in the elderly. The interesting activity and the good safety profile encourage the use of novel agents also in this setting of NSCLC. Adequate selection of elderly pts and personalized approach are still matters of debate. Use of adapted schedule and dose reduction could warrant a good compromise between safety and efficacy.
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P2.03a - Poster Session with Presenters Present (ID 464)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.03a-017 - Chemotherapy-Induced Nausea and Vomiting (CINV) in Italian Lung Cancer Patients: Assessment by Physician, Nurse and Patient (ID 4903)
14:30 - 14:30 | Author(s): M. Gianetta
- Abstract
Background:
Despite therapeutic advances, CINV still represents a common side-effect of chemotherapy and often its perception is not equal between patients and healthcare professionals. Aims of this study were to evaluate the agreement degree among clinicians, patients and nurses about CINV and other relevant items, and to understand whether anxiety, as well as other demographical and treatment-related factors, could play a role in CINV development.
Methods:
A dedicated survey was designed in agreement with a psychologist: 11 aspects (anxiety, mood, weakness, appetite, nausea, vomiting, pain, somnolence, breath, general status, and trust in treatments) were investigated through Numerical Rating Scale in four consecutive evaluations (T0, T1, T2 and T3) during first-line chemotherapy. From August 2015 to February 2016, the survey was administered in 11 Oncologic Institutions to 188 stage III/IV lung cancer patients and to their oncologists and nurses. Clinician versus patient (CvP), nurse versus patient (NvP) and clinician versus nurse (CvN) agreements were estimated in relation with the investigated items, applying Weighted Cohen's kappa and the grid of Landis and Koch. A multivariate logistic model was applied to evaluate factors possibly influencing anticipatory CINV development as perceived by patients before initiating chemotherapy (T0). Generalized Equation Estimates (GEE) for repeated measures were used to evaluate factors possibly influencing CINV development overall at T1, T2 and T3.
Results:
The incidence of CINV as reported by patients varied from 40.3% at T0 to 71.3% at T3. Both CvP and NvP concordances on the investigated items were mainly moderate, slightly increasing over time and becoming substantial for some items, in particular when evaluating NvP concordances. Pre-chemotherapy anxiety in all its mild (Odds Ratio [OR]: 4.99; 95% Confidence Interval [CI]: 1.26 – 19.81), moderate (OR: 4.89; 95% CI: 1.29; 18.50) and severe (OR: 4.70; 95% CI: 1.10; 19.98) manifestations, as well as mild (OR: 10.02; 95% CI: 3.27; 30.64), moderate (OR: 11.23; 95% CI: 3.54; 35.67) and severe (OR: 12.86; 95% CI: 2.83; 58.48) anxiety experienced after chemotherapy start, exposed patients to a higher risk of anticipatory CINV and of acute/delayed CINV respectively, as confirmed by the multivariate logistic model at T0 and by GEE overtime.
Conclusion:
Even if clinical staff revealed to be aware and sensitive about patients status and perceptions, CINV still represents a problem among patients undergoing chemotherapy, with this study further confirming that particular attention should be given to anxiety due to its key role in CINV development.
