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D. Flores-Estrada
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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): D. Flores-Estrada
- 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): D. Flores-Estrada
- 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.
