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Perran Fulden Yumuk
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P1.03 - Chemotherapy/Targeted Therapy (ID 689)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.03-040 - Smokers Having Activating EGFR Mutant Non-Small Cell Lung Cancer Might Benefit from EGFR-TKI Treatment - Single Center Experience (ID 9925)
09:30 - 09:30 | Presenting Author(s): Perran Fulden Yumuk
- Abstract
Background:
Epidermal growth factor receptor (EGFR) mutation is seen 15-20% in non-small cell lung carcinomas (NSCLC), more common in non-smokers, female sex and Asian population. Treating NSCLC patients having activating EGFR mutations with tyrosine kinase inhibitor (TKI) significantly prolongs progression-free survival compared to standard chemotherapy and is a more tolerable. Our aim is to evaluate clinicopathologic features of patients using EGFR directed therapies (erlotinib or gefitinib) longer than 1 year.
Method:
Files of 46 patients with metastatic NSCLC having activating EGFR mutations and treated with EGFR TKI between 2012-2017 were retrospectively evaluated. Statistical analysis was done by SPSS 16.
Result:
Median age was 61 (30-80), and 56.5% (26/46) was female. Mean follow-up was 38 months.The rate of smoking was 41% (19/46). LDH elevation was found in 67% and CEA elevation was found in 50% of the patients at presentation. Median progression-free survival time (mPFS) was 21 months (range 2-58). mPFS is 21 months (2-35) for patients using erlotinib in first line (35 patients), and 13 months (5-30) in second line setting (11 patients). Sixty four percent of patients had exon 19 deletion, 28% had exon 21 mutation, and 8% had activating exon 18 mutations. There were 27 patients with PFS 12 months or more and 9 patients with less than 12 months. No statistically significant difference was found for PFS when clinicopathologic features (age, gender, 1st or 2nd line usage, LDH or CEA levels, ECOG PS, smoking, weight loss, mutation status) of these patients were compared. Median overall survival time (mOS) for metastatic disease was 39 months (range 4-65). The negative effect of ECOG-PS on OS was shown by univariate and multivariate analysis. Skin toxicity was observed in 18 patients (43%), while treatment was interupted and dose was reduced in 6 patients (14%) due to side effects.
Conclusion:
Activating mutation in EGFR is the most important marker that predicts response to EGFR-TKIs in NSCLC. Smokers should be tested for EGFR mutations, as some patients may benefit from EGFR-TKI treatment for longer than reported in the literature.
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P2.02 - Biology/Pathology (ID 616)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.02-073a - Does the PD-L1 Status and TIL Intensity Change in NSCLC and Syncronous Brain Metastases? (ID 10118)
09:30 - 09:30 | Author(s): Perran Fulden Yumuk
- Abstract
Background:
Programmed death-ligand 1(PD-L1) expression in Non-small Cell Lung Carcinoma (NSCLC) is tissue based predictive marker. However, the differential expression of PD-L1 in tumor microenvironment between synchronous primary tumor in lung and metastatic side, especially brain metastasis remains unclear. This study addresses whether there is concordance of PD-L1 status and tumor infiltrating lymphocytes (TIL) together with intensity of CD8 lymphocytes, between the synchronous primary tumor and brain metastasis.
Method:
PD-L1 expression was evaluated immunohistochemically in primary lung tumor and synchronous brain metastasis by using the Dako PD-L1 IHC 22C3 pharmDx kit (SK006) . TIL were scored via CD3 and CD8 positivity immunohistochemically. PD-L1 expression was also compared with TIL proportion and intensity of CD8 lymphocytes between paired tumor tissues. All brain metastatic tissues had been removed before any treatment therefore;the study allowed the comparison of lung carcinoma and their native brain metastasis (BM).PD-L1 scoring was categorized based on the proportion of membranous immuno-positive tumor cells using cutoff values 0-1%, 1-49% and 50%. CD3 and CD8 positivity in TIL was evaluated semi quantitatively. Spearman rank correlation test was used for statistical analysis.
Result:
Primary tumor tissues and synchronous brain metastases of 24 NSCLC cases were included the study. Histopathological suptype of the cases were17/24 (70.83 % ) adenocarcinomas and 2/24 squamous cell carcinoma (8.3%), 1/24 adeno-squamous Ca.(4.16%) and 4/24 large cell carcinomas and pleomorphic carcinomas (16.6%). Tumor subtypes were the same in both primary tumor and BM specimen. In primary tumors, PD-L1 positivity was observed in 25% (6/24), 37.5% (9/24) and 37.5% (9/24) using cutoff values 0-1% , 1-49% and 50% respectively. PD-L1expresion score and pattern showed significant correlation in paired BM (Spearman rho= .731,p ˂0.001). However the PD-L1 expression on TIL cells and proportion of TIL infiltration was not demonstrated same concordance (Spearman rho= .548, p=0.006). When CD8 lyhmpocyte intensity among the TIL cells was compared between primary tumor and BM, only 54.16% (13/24) of the pair tumors were compatible.
Conclusion:
This study demonstrates that the concordance of PD-L1 expression between primary NSCLC and BM is very high. Thus, evaluation of PD-L1 in either primary lung tumors or brain metastasis would be useful for choosing anti PD-1/PD-L1 immunotherapy in patient with NSCLC with BM. Due to the low compatibility of CD8 intensity in TIL cells, may not be sufficient enough as a therapeutic target to use for both primary and brain metastases. Further research on this subject is required to gain deeper insigth in to the mecanism/biology of CD8 lymhpocites intensity in TIL cells and PD-L1 expression in NSCLC.
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P3.15 - SCLC/Neuroendocrine Tumors (ID 731)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: SCLC/Neuroendocrine Tumors
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.15-007 - A Retrospective Review of Small Cell Lung Cancer (SCLC) Patients Treated at Marmara University Hospital (ID 10251)
09:30 - 09:30 | Author(s): Perran Fulden Yumuk
- Abstract
Background:
SCLC accounts for 15%-20% of all lung cancer, and has poor prognosis. The aims of this study were to evaluate the patient characteristics and depict prognostic factors in a series of SCLC patients treated at Marmara University Hospital (MUH) Istanbul.
Method:
Among SCLC patients who were admitted to MUH since 01 January 2010, 154 had satisfactory data to analyse. Demographic data, pathology & radiology reports, lab investigations, information regarding local & systemic therapies were noted from written & electronic patient records. Patient and tumour characteristics were reported descriptively. OS difference between subgroups were analysed with Log-rank & factors that had independent effect on survival detected with Cox regression tests. OS data were calculated with Kaplan-Meier estimator. A p value <.05 was accepted as significant unless reported otherwise.
Result:
The median follow-up time was 17 (min-max; 3-84) months. Median survival time of all patients was 10 months; 1 year, 2 & 3 years survival rates were 41%, 22%, and 12%, respectively. Median survival of patients with limited stage and extension stage SCLC were; 22,6 Ms (9,9-35,3), and 9 Ms (7,2-10,8), respectively. On univariate analysis patient with low initial serum haemoglobin (<12 gr/dl), abnormal sodium or ALT (> 40 IU/l) levels, poor ECOG PS (2-3), advanced VA stage, having brain, liver, bone or adrenal mets, and having a paraneoplastic syndrome (PNS) had worse survival estimates. Whereas only ECOG PS (p=0.007, HR 2.2 [1.2-4]), and having a PNS (p=0.04, HR 1.66 [1.02-2.7]) maintained independent prognostic effect on survival in Cox analysis.
Conclusion:
Results of our small retrospective SCLC series showed that median survival of extensive stage SCLC patients is poor (< 1 year) which underlies the need of novel anticancer therapeutics for this group of patients. Our multivariate model pointed out well known prognostic factors but not the VA stage. This may be explained with the small population size of our study.
