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L. Campbell



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    P2.04 - Poster Session with Presenters Present (ID 466)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
    • Presentations: 1
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      P2.04-011 - Tumours of the Thymus: Northern Ireland 11 Year Experience (ID 5069)

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

      • Abstract

      Background:
      Tumours of the thymus are rare and consensus on their management is lacking. We aimed to assess outcomes of patients diagnosed over the last 11 years.

      Methods:
      We identified all patients diagnosed with thymic tumours in Northern Ireland between January 2004 and December 2015 as recorded in the Cancer Registry. Electronic Care Records were used for data collection.

      Results:
      Fifty-seven patients were identified, including 9 thymic carcinomas, 44 thymomas, 3 neuroendocrine tumours and 1 with small cell features. Mean age at diagnosis was 62 (16-82) and 26% presented with paraneoplastic phenomena. Of the thymoma patients, the majority presented with early stage disease (45.5% stage 1, 31.8% stage 2) and 86% had surgery. Ten patients received adjuvant radiotherapy (XRT), most received 50G in 20 fractions (#). Of those with advanced disease, only 3 received palliative chemotherapy. Various platinum-based regimes were used. Only 1 patient received any subsequent line of therapy. Generally thymic carcinomas presented later, with > 75% with stage 3 or 4 disease. Despite this, almost half (4/9) had surgery. Additionally, 2 received adjuvant XRT (between 40-50Gy) and 1 adjuvant chemoradiotherapy (Cisplatin/Etoposide, 50Gy 25#). 44.4% of these patients received palliative platinum-based chemotherapy, achieving modest partial responses at best. Median overall survival (OS) for thymoma (1) was 9.2 years compared to 6.2 years for thymic (2) carcinoma (p= 0.036)Figure 1



      Conclusion:
      Thymomas had a significantly better prognosis than thymic carcinomas suggesting that these are 2 different disease processes. The variability in treatments received reflects the lack of information and general consensus. Given the rarity of these tumours, greater emphasis must be placed on collaborative efforts, to increase patient numbers and obtain meaningful results that will increase our understanding of this challenging group of patients and improve outcomes.

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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-068 - Outcomes of Patients with Advanced EGFR Mutation Positive Adenocarcinoma of Lung Treated with Gefitinib in Northern Ireland 2010-2016 (ID 5328)

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

      • Abstract

      Background:
      First-line treatment with tyrosine kinase inhibitors (TKIs) improves overall response rates (RR) and progression free survival (PFS) within trial populations with advanced adenocarcinoma of the lung harbouring gain of function EGFR mutations, when compared to platinum based doublet chemotherapy. Moreover, TKI therapy is associated with improvement in quality of life and better toxicity profile. Gefitinib was the first such drug to be approved by NICE for this purpose. We aimed to investigate the outcomes of Gefitinib therapy in a non-trial population.

      Methods:
      Patients diagnosed with metastatic lung adenocarcinoma, with an EGFR activating mutation and subsequently treated with Gefitinib in Northern Ireland between 2010 and 2016 were identified by means of an electronic database. The Adult Comorbidity Evaluation scale (ACE-27) determined overall co-morbidity scores.

      Results:
      Thirty patients received gefitinib for this indication. The majority were female (n= 19, 63%), Caucasian (n=27, 90%) and never smokers (n=13, 54%). Mean age at diagnosis was 63 (43-86) and all were performance status (PS) ≤2. Exon 19 deletion and L848R accounted for 65.5% of mutations. 26 patients were evaluable for response. 3 died prior to CT assessment. Disease control rate was 69% (42% partial response + 30.7% stable disease). Grade 3/ 4 toxicity included rash (3.3%) and hepatotoxicity (13%). Median PFS was 211 days (55-684) and OS was 441 days (61-1428). An ACE-27 score>1 was associated with significantly poorer PFS (57 vs 246d, p=0.0007) and OS (91 vs 549d, p=0.0017), as was PS 2. Compared to other EGFR mutations, patients harbouring L858R also had inferior survival rates (PFS: 130 vs 260 d, p=0.006, OS: 312 vs 563d, p=0.0031).Figure 1



      Conclusion:
      Gefitinib was well tolerated; however RR and PFS were lower than those reported in clinical trial, possibly reflecting our small, unselected population. High ACE-27 score, PS2 and L858R mutation were significantly associated with inferior survival.