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L. Ramirez-Tirado
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MA 08 - Supportive Care and Communication (ID 669)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Nursing/Palliative Care/Ethics
- Presentations: 1
- Moderators:E. Esposito-Nguyen, John McPhelim
- Coordinates: 10/17/2017, 11:00 - 12:30, Room 511 + 512
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MA 08.10 - Favorable Clinical Status Predicts Benefit From Early-Palliative Cares & OS Improvement in NSCLC: A Randomized Clinical Study (ID 10348)
12:05 - 12:10 | Author(s): L. Ramirez-Tirado
- Abstract
- Presentation
Background:
Early-palliative care (EPC) after lung cancer diagnosis is essential for a better quality-of-life (QoL), and even offers a substantial improvement in survival outcomes. We prospectively assessed the effect of EPC in overall survival (OS) and patient-reported outcomes in non-small cell lung cancer (NSCLC) patients.
Method:
Newly-diagnosed and treatment-naïve NSCLC patients were included and randomly assigned (1:1) to receive either EPC with oncologic, nutritional, and psychological care, or standard oncologic care alone. Assessments were performed at baseline, second, fourth and sixth cycle of chemotherapy, with evaluations including: QoL, evaluated by The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, depression and anxiety which were evaluated using the Hospital Anxiety and Depression Scale, and oncologic symptomatology, which was evaluated with the Edmonton System Assessment Scale. NCT01631565 [013/020ICI(CV773/13)].
Result:
Ninety-six NSCLC patients were enrolled; 42 patients were allocated to EPC while 54 patients were allocated to standard-care. Overall, patients receiving EPC have lower self-reported symptoms, depression and anxiety. Median OS of patients with EPC was 11.1 months (95% CI: 8.4–13.9), while in patients with standard-care was 5.9 months (95% CI: 4.8 – 7.1); p=0.049. In the multivariate analysis, factors associated with worse OS were: patients in standard-care arm (HR, 95% CI 1.6 (0.9 – 2.7); p=0.05), male patients (HR, 95% CI 1.8 (1.1 – 3.0); p=0.028) and worse ECOG performance status (≥2) (HR, 95% CI 1.9 (1.0 – 3.5); p=0.039).In a subgroup analysis, patients who reaped the most benefit from EPC included those with better ECOG performance status (<2) (8.9 vs. 5.7 months; p=0.05); those without depression at baseline (14.8 vs. 6.5 months; p=0.05) and those Corroborar que si sea mayor ansiedad basal-mayor beneficio Figure 1
Conclusion:
EPC might provide benefit in the clinical symptomatic burden and OS of NSCLC patients. Benefits from EPC in OS might be associated to favorable global clinical status.
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P1.01 - Advanced NSCLC (ID 757)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.01-019 - ALK+ Non-Small Cell Lung Cancer Treated with First Line Crizotinib: Patient Characteristics, Treatment Patterns, and Survival (ID 10137)
09:30 - 09:30 | Author(s): L. Ramirez-Tirado
- Abstract
Background:
This study describes the characteristics, treatment sequencing, and outcomes among locally advanced/metastatic crizotinib-treated ALK+ Non-small cell lung cancer (NSCLC) Hispanic patients.
Method:
From June 2014 to June 2017, a retrospective patient review was conducted among several centers from México (n=10), Costa Rica (n=4), Panamá (n=13), Colombia (n=16), Venezuela (n=10), and Argentina (n=20). Participating clinicians identified their ALK+ NSCLC patients who received crizotinib and reported their clinical characteristics, treatments, and survival using a pre-defined case report form. Kaplan-Meier analyses were used to describe overall survival (OS) and progression-free survival (PFS).
Result:
73 ALK+ NSCLC patients treated with crizotinib as a first line were included. Median age at diagnosis was 62 years (range, 34-77), 60.3% were female and histological distribution was adenocarcinoma in 93.2%, squamous cell carcinomas in 2.7%, NOS in 2.7% and adenosquamous in 1.4%. Sixty-five patients (89%) were never or former smokers, 52 (71.1%) had ≥2 sites of metastasis and 15 (20.5%) had brain metastasis at diagnosis. Median PFS to treatment with first line crizotinib was 12.3 months (95%CI 9.4-15.3) and overall response rate (ORR) was 52% (CR 6.8% and PR 45.2%). Of those who discontinued crizotinib, 26.1% had brain progression, 35.6% switched to chemotherapy, 14% switched to a different ALK inhibitor and 59% received no further therapy. After starting crizotinib, median OS was 32.5 months (95%CI 25.6-39.4), 42.6 months (95%CI 31.8-53.5) for those who received ceritinib or/and alectinib, and 23.8 months (95%CI 19.0-28.6) among those treated with second line platinum based chemotherapy (p=0.003).
Conclusion:
The ORR and PFS observed in Hispanic patients with ALK+ NSCLC treated with first-line crizotinib was similar to that previously described. Limited access to new-generation ALK inhibitors affects OS. Those patients exposed to ceritinib or alectinib demonstrated a significant improvement in OS versus those treated with second-line platinum-based chemotherapy.
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P2.01 - Advanced NSCLC (ID 618)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:00 - 16:00, Exhibit Hall (Hall B + C)
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P2.01-070 - FAACT- Anorexia Cachexia Scale: Cut-Off Value for the Anorexia Diagnosis in NSCLC Patients (ID 9504)
09:00 - 09:00 | Author(s): L. Ramirez-Tirado
- Abstract
Background:
Lung cancer has the highest death rate among cancer types and anorexia is reported by a high percentage of patients, but the prevalence values may vary according to form of diagnosis. Anorexia is associated with reduced food intake, weight loss and a negative affect in quality of life and worse outcome. There is no gold standard for anorexia diagnosis. The anorexia cachexia scale (AC/S) from FAACT instrument has been proposed as a tool for diagnoses anorexia but a validated cut-off value for NSCLC patients is required. This study validates a cut-off value of AC/S for anorexia diagnosis in NSCLC patients.
Method:
The AC/S were evaluated in Non-Small Cell Lung Cancer (NSCLC) patients to establish a cut-off value by ROC curve analysis and CutOff Finder program with the anorexia score from QLQ-C30 questionary as a standard reference and by X-tile based on survival. The cut-off value was associated with clinical parameters
Result:
Three hundred and twelve ambulatory NSCLC patients were evaluated, 67% with adenocarcinoma, 65% stage IV and 98% with ECOG ≤2. The mean of AC/S was 31 ± 9 and the identified cut-off value was 32.5, sensitivity 80.3% (85.7-73.3) and specificity 85% (90%-78.2). The proportion of anorexia based on cut-off value of 24 was 26% and with cut-off value of 32 was 50%. AC/S cut-off value 32 was associated significantly with clinical parameters, nutritional consumption and quality of life. Overall survival was determined in all patients, stage III/IV and stage IV. The overall survival was independently associated with the cut-off value of 32. Figure 1
Conclusion:
Lung cancer patients with the score of ≤32 in AC/S for anorexia diagnosis is proposed, clinically useful and this cut-off can improve the identification of patients with a risk of complications of cancer related malnutrition. Future treatments and follow ups of cancer-related anorexia should be focus in this patients.
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P3.14 - Radiotherapy (ID 730)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.14-012 - Risk of Developing Pneumonitis Increases in Patients Receiving Immunotherapy with a History of Lung Irradiation (ID 10344)
09:30 - 09:30 | Author(s): L. Ramirez-Tirado
- Abstract
Background:
A large proportion of patients with locally advanced/metastatic Non-Small Cell Lung Cancer (NSCLC) present disease progression despite aggressive treatments and will further receive immunotherapy. Pneumonitis is an uncommon but potentially fatal toxicity related to immunotherapy treatment. The association with the history of radiotherapy and the risk of developing pneumonitis have not been well described. We associated the history of radiotherapy with the development of pneumonitis in patients receiving immunotherapy.
Method:
Clinical information was retrospectively obtained from histologically confirmed advanced NSCLC patients treated from February 2013 to February 2017. Clinical and radiologic features of pneumonitis were collected from patients receiving immunotherapy. We sought associations between pneumonitis incidence and clinical characteristics.
Result:
Of 59 patients who received immunotherapy 61.7% were treated with nivolumab, 29.9% with pembrolizumab and 6.7% with the combination durvalumab plus tremelimumab. Immunotherapy treatment was administered in first line in 26.6% of patients, 28.3% received in second line and 36.7% in third or more line of treatment. Twenty-five of the 59 patients (41.7%) received previous radiotherapy, 16 of them (26.7%) to the lung and 9 (15%) to the thoracic spine. Fifteen (15/59) patients (25%) developed pneumonitis; this occurred irrespective of line of therapy in which immunotherapy was received (first line: 38.5%; second line: 33.5%; third line or more: 26.7%). No association was found between line of treatment and pneumonitis development. Median time from therapy initiation to pneumonitis was 4.5 months (range 18 days - 13.1 months). For any grade of pneumonitis, the percentage was of 25% (15 patients) of which 48% (12/25) had received radiotherapy, Grade >2 pneumonitis was seen in 10 patients (17%) and 32% (8/25) had history of radiation therapy. All Grade 3 pneumonitis events (n=4) presented in patients with previous lung radiotherapy. The incidence and severity of pneumonitis was higher in patients who had received radiotherapy (OR, 95% CI: 6.8 (1.6 – 28.5); p=0.009).
Conclusion:
The incidence of pneumonitis related to immunotherapy treatment could be underestimated. We observed an increase in the risk and severity of pneumonitis in patients with previous radiation therapy and subsequent treatment with immunotherapy, regardless of used drug or line of therapy. In these patients, we recommend close clinical and radiologic follow-up.
