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I. Santoro
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OA17 - Aspects of Health Policies and Public Health (ID 397)
- Event: WCLC 2016
- Type: Oral Session
- Track: Regional Aspects/Health Policy/Public Health
- Presentations: 1
- Moderators:M. Kneussl
- Coordinates: 12/06/2016, 16:00 - 17:30, Schubert 1
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OA17.05 - Survival in a Cohort of Patients with Lung Cancer: The Role of Age and Gender on Prognosis (ID 6310)
16:45 - 16:55 | Author(s): I. Santoro
- Abstract
- Presentation
Background:
Lung cancer has a high incidence in Brazil; approximately thirty-four thousand new cases are diagnosed each year. In Brazil, as in other countries, the majority of patients diagnosed with lung cancer are elderly. There are few studies that evaluate demographic and clinical characteristics, disease staging, treatment modalities and survival in young patients, mostly carried out in developed countries. This study aimed to describe these aspects in patients with non-small cell lung cancer (NSCLC) according to age.
Methods:
Retrospective cohort consisted of patients diagnosed with NSCLC followed in a referral hospital in São Paulo. During the monitoring the survival time was evaluated. Survival functions were calculated using the method of Kaplan-Meier. The survival stratified by age was also obtained, according to distribution of percentages (less than 55; between 55 and 72 years; older than 72 years). Differences between survival curves were determined using the log-rank test.
Results:
From January 2000 to July 2015 790 patients were followed, 165 aged less than 55 years, 423 between 55 and 72 years and 202 older than 72 years. Higher incidence of adenocarcinoma was seen at the groups up to 72 years. 575 (73%) patients with advanced disease (IIIB-IV stages) were observed. The median five-year survival was 12 months [46-4]. The survival of patients in different age groups was not different.
*Chi-square test; † Kruskal-Wallis (Duncan test); ‡oneway ANOVA (Bonferroni test).<55 165 >55<72 423 >72 202 p Male n(%) 87 (53) 279 (66) 127 (63) 0.012* Smoke n(%) 136 (82) 363 (86) 165 (82) 0.34* Male 78 (90) 263 (94) 121 (95) 0.21* Female 58 (74) 100 (69) 44 (59) 0.10* Histological type n(%) 0.13* Adenocarcinoma 92 (56) 216 (51) 91 (45) Squamous Cell Carcinoma 52 (32) 170 (40) 91 (45) Staging n(%) 0.057* IA/IIIA 34 (21) 127 (30) 52 (26) IIIB/IV 131 (79) 294 (70) 150 (74) Deaths n (%) 83 (50) 232 (55) 105 (52) 0.56* Follow-up (months) Median[IIQ] 4.9 [1.3-13.2] 6.5 [2.0-16.3] 4.4 [1.4-12.9] 0.07†
Conclusion:
In the age group of younger patients (<55) women predominated, histological type adenocarcinoma was more frequent, and there were more patients with advanced stage at the diagnosis and a higher percentage of smokers in both genders.
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OA23 - EGFR Targeted Therapies in Advanced NSCLC (ID 410)
- Event: WCLC 2016
- Type: Oral Session
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:O.T. Brustugun, S. Lu
- Coordinates: 12/07/2016, 14:20 - 15:50, Stolz 2
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OA23.01 - Anti-EGFR Monoclonal Antibodies plus Chemotherapy in the First-Line Treatment of Advanced NSCLC: A Meta-Analysis (ID 4135)
14:20 - 14:30 | Author(s): I. Santoro
- Abstract
- Presentation
Background:
Monoclonal Antibodies (mAbs) against the Epidermal Growth Factor Receptor (EGFR) in association with platinum-based doublet chemotherapy have emerged as a potential first-line treatment option for advanced non-small cell lung cancer (NSCLC). This study was conducted to systematically review available data and evaluate the efficacy and toxicity of anti-EGFR mAbs plus chemotherapy vs chemotherapy alone for advanced NSCLC.
Methods:
We carried out a search on network databases and oncology conference abstracts for studies between 1990 and January 2016. Only prospective randomized clinical trials were included. Primary endpoints were overall survival (OS) and toxicity frequency. Secondary endpoints were progression-free survival (PFS) and overall response rate (ORR). Subgroup analysis was performed assessing histological subtypes, EGFR protein expression by immunohistochemistry (IHC), EGFR gene copy number by fluorescence in-situ hybridization (FISH), EGFR mutation status, and smoking status.
Results:
Seven studies (2 with necitumumab and 5 with cetuximab) were included with 5,057 patients. Compared to chemotherapy alone, significant benefits were demonstrated by the addition of anti-EGFR mAb to chemotherapy in OS (HR 0.90; 95%CI 0.84-0.95), PFS (HR 0.93; 95%CI 0.87-0.98), and ORR (OR 1.27; 95%CI 1.06-1.51). In subgroup analyses, the association of anti-EGFR mAb was associated with improved OS among patients with squamous histology (HR 0.84; 95%CI 0.76-0.92), tumours with high EGFR expression by IHC (HR 0.83; 95%CI 0.70-0.98), and smokers (HR 0.87; 95%CI 0.79-0.96). Patients with squamous histology and high EGFR expression by IHC achieved the highest benefit with the association (HR 0.71; 95%CI 0.59-0.86). The OS with the association also seemed to be higher in EGFR FISH negative and in EGFR wild-type tumours, but without statistical significance. Chemotherapy plus anti-EGFR mAb caused more grade 3 or worse adverse events (OR 1.73; 95%CI 1.50-2.00), remarkedly these known to be associated with anti-EGFR therapy, such as acne-like rash (OR 34.13; 95%CI 16.40-71.00) and hypomagnesemia (OR 6.23; 95%CI 3.04-12.77).
Conclusion:
Anti-EGFR therapy plus platinum-based doublet chemotherapy as first-line treatment demonstrated significant efficacy benefits with acceptable toxicity for advanced NSCLC. This benefit is more expressive among squamous histology with high EGFR expression. EGFR protein expression by IHC seems to be a predictive marker for survival in the association group. Further research is needed to corroborate these findings.
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