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N. Farré



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    OA05 - Treatment Advances in SCLC (ID 373)

    • Event: WCLC 2016
    • Type: Oral Session
    • Track: SCLC/Neuroendocrine Tumors
    • Presentations: 1
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      OA05.06 - Compliance and Outcome of Elderly Patients Treated in the Concurrent Once-Daily versus Twice-Daily RadioTherapy (CONVERT) Trial (ID 4061)

      14:20 - 15:50  |  Author(s): N. Farré

      • Abstract
      • Presentation
      • Slides

      Background:
      A significant proportion of limited-stage small cell lung cancer are elderly. However, there is paucity of data on the efficacy and safety of concurrent chemo-radiotherapy in the elderly to guide treatment decision-making.

      Methods:
      Data from the CONVERT trial was retrospectively analysed to compare the outcome of patients 70 years or older to patients younger than 70 years. Patients were randomised 1:1 to receive 45Gy in 30 twice-daily fractions over 3 weeks or 66Gy in 33 once-daily fractions over 6.5 weeks starting on day 22 of cycle 1 chemotherapy (4 to 6 cycles of Cisplatin 25mg/m2 days 1-3 or 75mg/m2 day 1 with Etoposide 100mg/m2 days 1-3), followed by Prophylactic Cranial Irradiation if indicated. Radiotherapy planning was with a 3D conformal technique or intensity modulated radiotherapy.

      Results:
      Of 547 patients randomised between April 2008 and November 2013, 57 patients were excluded for the purposes of this analysis as they did not receive concurrent chemo-radiotherapy. Of the 490 included patients, 67 (13.7%) were age 70 years or older with median age of 73 years (70-82). Patients’ characteristics were well balanced apart from more male in the elderly group (p=0.02). There was no significant difference in the number of chemotherapy cycles administered in the two groups (p=0.24). A higher proportion of patients received 30 or 33 fractions of radiotherapy as per protocol in the younger group (85% vs. 73%; p=0.03). Neutropenia grade 3/4 occurred more frequently in the elderly group (84% vs. 70%; p=0.02) but there was no statistically significant difference in neutropenic sepsis (4% vs. 7%; p=0.07) and non-haematological acute/late toxicities. There were two vs. six treatment-related deaths in the elderly and younger group respectively (p=0.67). At median follow up of 46 months for those alive; two-year survival was 53% (95% CI 41-64) vs. 57% (95% CI 52-61), median survival was 29 months vs. 30 months in the elderly vs. younger group respectively. Hazard ratios for overall survival and progression free survival were 1.15 (95% CI 0.84-1.59; log-rank p=0.38) and 1.04 (95% CI 0.76-1.41; log-rank p=0.81) respectively. In the elderly group median survival was not significantly different in patients who received once vs. twice daily radiotherapy (p=0.91).

      Conclusion:
      Radiotherapy treatment delivery was higher in the younger group but toxicity and survival rates were similar in elderly compared to younger patients. Concurrent chemo-radiotherapy with modern radiotherapy techniques is a treatment option for elderly patients with good performance status.

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    P1.02 - Poster Session with Presenters Present (ID 454)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Biology/Pathology
    • Presentations: 1
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      P1.02-067 - Repeated Biopsy for Immunohistochemical and Mutational Analysis of Non Small Cell Lung Cancer: Feasibility and Safety (ID 4442)

      14:30 - 15:45  |  Author(s): N. Farré

      • Abstract

      Background:
      Repeated biopsy in lung cancer may be necessary at diagnosis or after cancer progression on initial therapy to properly target treatments. The objective of this study is to evaluate the feasibility and safety of repeated biopsy for immunohistochemical and/or mutational analysis in patients with non small cell lung cancer.

      Methods:
      We have retrospectively analyzed repeated biopsies performed in patients with advanced non small cell lung cancer during the last 4 years. The technical success rates for the repeated biopsy and the adequacy rates of specimens were evaluated. Biopsy-related complications were recorded. Clinical details were collected, specially focusing in EGFR mutation data.

      Results:
      110 repeated biopsies were performed in 74 patients (34 women, 40 men, mean age 63 [36-84]), the histology was: 74% adenocarcinoma, 12% squamous cell carcinoma, 11% NOS, 3% other. The mean number of repeated biopsies per patient was 1 (1-4). The main reasons for repeated biopsy were immunohistochemical +/- mutational analysis (34/110, 31%), mutational analysis (16/110, 14.6%) and EGFR at progression (28/110, 24.4%). The technical success rate for biopsy was 98/110 (89.1%), and postprocedural complications occurred in 3/110 cases: 2 pneumothorax and 1 wound infection. Biopsy specimens came mostly from primary tumor (56/110, 51%), lymph nodes (26/110, 23.6%) and pleura (9/110, 8.2%), the most used technique was bronchoscopy +/- EBUS (45/110, 40%), followed by percutaneous transthoracic lung biopsy (28/110, 26%) and thoracoscopy and/or mediastinoscopy: (19/110, 17%). Results from repeated biopsy were used to select the next line of treatment in 86/110 procedures (78%), and 40/86 of them (46.5%) allowed to include the patient in a clinical trial. 28 repeated biopsies were performed in 21 EGFR mutant lung cancer patients with acquired resistance at disease progression, T790M was detected in 13/28 (46%) of samples, corresponding to 10/21 (47.6%) EGFR mutant lung cancer patients.

      Conclusion:
      Our data demonstrate that repeated biopsy in non small cell lung cancer is safe and clinically feasible. Findings from repeated biopsy were used to direct subsequent treatment in 78% of patients.

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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
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      P2.04-013 - Prognosis Factors and Survival Analysis in Thymic Epithelial Tumors (ID 5919)

      14:30 - 15:45  |  Author(s): N. Farré

      • Abstract

      Background:
      Thymic epithelial tumors (TET) include thymomas (T) and thymic carcinomas (TC). TET are rare malignant tumors usually associated with paraneoplastic syndromes (PNPS). The objective of the study is to describe our experience and to analyze the prognostic factors.

      Methods:
      Retrospective analysis of the clinical and pathological characteristics of 42 patients (pts) diagnosed with TET in our institution from 1990 to 2016. We analysed the outcomes in terms of progression-free survival (PFS) and overall survival (OS) and their association with clinical factors: age, perfomance status, presence of PNPS, TNM staging, WHO classification, complete resection and treatment. Kaplan Meier method and Cox regresion were used.

      Results:
      Mean age:55 years (27-86). 19 (45.2%) : women. First treatment: surgery in 34 pts (81%) and platinum based chemotherapy in 6 pts (14%). 2 pts (5%) were untreated. 14 pts (41%) received postoperative radiotherapy. WHO classification: 6 pts (14.3%) type A, 12 (28.6%) AB, 3 (7.1%) B1, 7 (16.7%) B2, 7 (16.7%) B3 and 7 (16.7%) C. TNM staging: 20 pts (48.8%) stage I,4 (9.8%) stage II, 6 (14.6%) stage III and 9 (22%) stage IV. 25 ptss (59.5%) had PNPS at diagnosis: 21 (50%) myasthenia gravis, 2 (4.75%) aplastic anemia and 2 (4.75%) others. Table 1 shows OS and PFS according to WHO classification:

      WHO C WHO: A, AB, B1, B2, B3 p value HR (univariate) p value
      PFS (months)(95%CI) 21.2 (5.8-36.7) 89.3(69.1-109.6) 0.03 3.12 0.04
      OS (monthS)(95%CI) 66.5 (0-157.5) 296 (98.6-493.3) <0.001 20.2 0.007
      The presence of PNPS were associated with better OS than those without PNPS (236m , 95%CI 147-448m vs 66.5m, 95% CI 1.3-131.7m, p=0.006, HR 0.76, p=0.026 ) and also with early diagnosis (stage I for pts with PNPS 56% vs 42% without PNPS ). In the multivariate analisys, only C type remained stadistically significant (HR:13.5, p=0.024). No diferences were found when using TNM classification or complete resection.

      Conclusion:
      Patients with C type TET had worst prognosis. The presence of a PNPS is associated with better OS possibly due to and early diagnosis.