Author of

• 17728

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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
  • Moderators:
  • Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 17760

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    P2.04-032 - Pulmonary Sarcomatoid Carcinoma (PSC): Experience of 45 Patients at a Comprehensive Cancer Center (ID 5389)

    14:30 - 14:30  |  Author(s): N. Khan
    • Abstract

    Background:
    Pulmonary sarcomatoid carcinoma is rare and standard therapy is not well defined. We evaluated experience at our center to identify factors influencing the outcome.
    
    Methods:
    We performed a retrospective review of PSC patients (pts) treated at Roswell Park Cancer Institute between 1972 and 2014.
    
    Results:
    45 pts were identified. Cohort consisted predominantly of males (55%), Caucasians (91%) and smokers (87%) with an average 47 pack-year smoking history. Median age at diagnosis was 63 years. 22% presented with stage I, 25% with stage II, 22% with stage III and 31% with stage IV at diagnosis. All 13 pts tested for EGFR mutation were wild type. Mutations in KRAS were present in 3/11, ROS1 in 0/2, ALK in 0/9, RET in 0/2, BRAF in 0/2 and MET amplification in 1/2 pts. 29 pts underwent surgery. 80% had video assisted thoracoscopic surgery with 26 undergoing lobectomy and 3 pneumonectomy. 7 pts (16%) had neoadjuvant chemotherapy (CT). 6 of these received a cisplatin-based doublet (with gemcitabine, etoposide or pemetrexed), 1 received sarcoma-like regimen with cisplatin, paclitaxel and ifosfamide. 6 pts had partial response (PR) and 1 had progressive disease (PD). Adjuvant chemotherapy (AC) consisting of a platinum-based doublet was given in 10 pts. 41% pts who underwent surgery relapsed. Local relapse in the lung was the most common (77%). Systemic CT was given in 19 pts with stage IV or relapsed disease. First line CT was a platinum-based doublet in 74% pts. After a median of 2 cycles, only 1 patient had PR and 1 had stable disease. 88% pts had PD on first-line CT. Second-line CT was given in 11 pts, with combination or single agent (platinum, docetaxel, irinotecan, pemetrexed) or EGFR inhibitors in 3 pts. 5 pts underwent third-line CT. No pts had response to second- or third-line CT. Median progression free survival (PFS) was 4.9 months (m) and overall survival (OS) was 12.2 m and significantly depended on stage at diagnosis. Stage IV pts had PFS of 2.4 m and OS of 3.4 m. Pts receiving AC had significantly improved PFS (37 vs 13 m; p=0.026) and OS (48 vs 22 m; p=0.025).
    
    Conclusion:
    PSC heralds a poor prognosis and no standard management guidelines exist. AC is associated with significant improvemt in survival. Local relapse is the most common failure pattern in early-stage disease. In advanced stages, cytotoxic CT is ineffective with a short survival. There is a dire need for newer therapies.