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J. Hanaoka



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    MO18 - NSCLC - Targeted Therapies IV (ID 116)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Medical Oncology
    • Presentations: 1
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      MO18.04 - MUC1-targeted dendritic cell-based vaccines in patients with standard treatments-refractory non-small-cell lung cancer (ID 3215)

      16:15 - 17:45  |  Author(s): J. Hanaoka

      • Abstract
      • Presentation
      • Slides

      Background
      MUC1, a tumor antigen, has been considered to be a promising target antigen for cancer immunotherapy because it possesses a potent immunogenicity. It is processed and presented by antigen-presenting cells in a MHC-unrestricted pattern. Dendritic cell-based vaccine immunotherapy can elicit antigen-specific cytotoxic T lymphocytes in tumor-bearing hosts, and activated cytotoxic T lymphocytes are expected to attack cancer cells. In this study, we evaluated the efficacy of MUC1-targeted dendritic cell-based vaccine immunotherapy in patients with standard treatments-refractory advanced non-small-cell lung cancer (NSCLC).

      Methods
      The eligibility criteria of this immunotherapy were as follows: histologic or cytologic evidence of NSCLC that express MUC1 protein abundantly; an Eastern Cooperative Oncology Group performance status of 0-2; advanced stage of diseases refractory to any standard cancer treatments. The dendritic cells were prepared from peripheral blood mononuclear cells with cytokines interleukin-4 and granulocyte macrophage colony stimulating factor, pulsed with MUC1 peptides, and subsequently administered to patients by subcutaneous injection. The vaccinations were repeated bi-weekly, and assessable patients were received at least 6 vaccinations. Tumor response was assessed according to the Response Evaluation Criteria in Solid Tumors. Adverse events were graded according to National Cancer Institute Common Toxicity Criteria.

      Results
      From June 2005 to December 2012, 36 patients were treated with dendritic cell-based vaccines, and 25 patients (69.4%) with median age of 61 years (range, 49-84 years) were assessable for tumor responses. The cohort consisted of 14 males and 11 females, and 22 patients had adenocarcinomas; 2 patients with squamous cell carcinomas and 1 patient with pleomorphic carcinoma. Among these patients, neither complete response nor partial response was obtained. Fourteen patients had progressive disease as the best response, and 10 patients had stable disease, yielding overall disease control rate of 40.0% (95%CI=20.8-59.2). Median survival time after the vaccines was 10.0 months, and 1-year survival rate was 32.3%. Adverse events related to the vaccines were less frequent. Immunological responses could be monitored in five patients, showing that MUC1-specific cytotoxic responses of effector immune cells were achieved in all of those patients, and the population of regulatory T lymphocytes in peripheral blood cells was decreased after the vaccines.

      Conclusion
      MUC1-targeted dendritic cell-based vaccine immunotherapy is feasible, and has a potential to control the diseases in patients with refractory NSCLC.

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    P2.07 - Poster Session 2 - Surgery (ID 190)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P2.07-007 - Surgical treatment of elderly patients with resectable lung cancer (ID 832)

      09:30 - 16:30  |  Author(s): J. Hanaoka

      • Abstract

      Background
      The incidence of lung cancer in the older population is increasing. In case of resectable primary lung cancer, surgery remains the best treatment for cure, independent of age. However, the prevalence of co-morbidities among elderly lung cancer patients is significantly higher. A presumed fear of increased postoperative morbidity and mortality in the elderly patients has resulted in the delivery of sub-optimal cancer surgery. We believe all elderly cancer patients should be offered optimal treatment depending on their functional status not on their age; a major step in ensuring this would be to establish the appropriate surgical management protocol for elderly cancer patients. Thus it is important to determine whether the elderly would indeed benefit from the same management standards as their younger counterparts. This study aimed to determine the suitable operative procedures for elderly patients with primary lung cancer.

      Methods
      Between January 2006 and December 2012, 98 patients aged over 75 years with primary lung cancer received lobectomies in our hospital. We divided the patients into group A (75-79 years old) and group B (over80 years old) and analyzed their relapse-free survival and postoperative complication incidence.

      Results
      The patients in group A (46 men and 17 women) had a mean age of 76.8 years, 36 patients had adenocarcinomas, 24 had squamous cell carcinomas, and 3 had other tumors. A mediastinal lymph node dissection (MLND) was performed in 52 patients but not in 11 patients. The patients’ pathological stages were 1A (21), 1B (13), 2A (5), 2B (12), 3A (11), and 4 (1). The 3-year relapse-free survival was 66.3 % (MLND-positive, 62.6 %; MLND-negative, 90.9 %). Postoperative complications occurred in 30.8 % of the MLND-positive patients and 18.2 % of the MLND-negative patients. The patients in group B (26 men and 9 women) had a mean age of 82.4 years, 17 patients had adenocarcinomas, 12 had squamous cell carcinomas, and 6 had other tumors. An MLND was performed in 24 patients but not in 11 patients. The patients’ pathological stages were 1A (12), 1B (10), 2A (5), 2B (3), 3A (1), and 3B (4). The 3-year relapse-free survival was 73.3 % (MLND-positive, 75.7 %; MLND-negative, 68.2 %). Postoperative complications occurred in 16.7 % of the MLND-positive patients and 9.1 % of the MLND-negative patients.

      Conclusion
      This study showed a survival benefit in elderly lung cancer patients who underwent lobectomies. In clinically well-documented early nodal stage disease (N0 patients and N1 patients with limited hilar disease), an MLND did not have a therapeutic effect and thus may not be necessary. Omitting MLNDs in elderly lung cancer patients also provided fewer postoperative complications. In this study, we proved that elderly patients with resectable lung cancer who received lobectomies without MLNDs could achieve long-term survival and be a safe procedure.

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    P2.15 - Poster Session 2 - Thymoma (ID 191)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Thymoma & Other Thoracic Malignancies
    • Presentations: 1
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      P2.15-006 - Retrospective study on the efficacy of multidisciplinary therapy for thymic cancers (ID 2259)

      09:30 - 16:30  |  Author(s): J. Hanaoka

      • Abstract

      Background
      Thymic cancer is relatively rare malignant disease, and the therapeutic strategy remains to be explored. The purpose of this study is to evaluate the clinical features of thymic cancers after multidisciplinary therapy.

      Methods
      From January 2004 to December 2012, 13 patients were diagnosed with thymic cancer in our hospital. Clinical features of 12 cases except 1 case who was given best supportive care from the beginning were evaluated retrospectively.

      Results
      The mean age of patient was 62 years old, ranging 41 to 79 years old. Stages of tumors according to Masaoka staging system were as follows; the number of patients with stages 1/2/3/4A/4B was 1/2/4/0/5, respectively. The pathological subtypes of the tumor according to the WHO histological criteria included squamous cell carcinomas in 7 cases, adenocarcinomas in 3, large cell neuroendocrine carcinoma (LCNEC) in 1 and undifferentiated carcinoma in 1. Of 12 patients, 6 patients (50.0%) underwent complete resection of both tumor and thymic tissues (Surgery group, the number of patients with stage 1/2/3/4A/4B=1/2/2/0/1) and others (50.0%) received chemo-radiotherapy (Non-surgery group, the number of patients with stage 1/2/3/4A/4B = 0/0/2/0/4). In Surgery group, 5 patients (83.3%) received adjuvant radio- or chemotherapy. Despite of multidisciplinary therapy, recurrences of the tumor were observed in 2 cases (33.3%) with pathological subtypes of adenocarcinoma and LCNEC. The median disease free survival after surgery in Surgery group was not reached at the time of this analysis. Kaplan-Meier analysis revealed that the median survival times after the treatment in Surgery and Non-surgery groups were 53.0 and 18.0 months, respectively, indicating that patients in Surgery group had significant longer survival than those in Non-surgery group (P=0.049, log-lank test).

      Conclusion
      Multidisciplinary therapy including complete resection of tumors can achieve better therapeutic outcomes. Non-squamous cell carcinomas are likely to be subtypes with poor prognosis despite of multidisciplinary therapy.

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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-017 - 5 cases of long-term survival in posterior spinal fixation surgery against vertebral metastasis of lung cancer (ID 1251)

      09:30 - 16:30  |  Author(s): J. Hanaoka

      • Abstract

      Background
      Recently, with the progress of treatment, the patients showing prolonged survival has increased in advanced lung cancer. Even though local treatments for the patients with vertebral metastasis, such as radiation therapy and/or surgery, are considered with effective, the indication of the treatment has not been determined. We report 5 cases who underwent posterior spinal fixation, they could maintain ADL(Activities of Daily Livings) well and could keep a long-term prognosis.

      Methods
      Between December 2012 and June 2004, we objectively evaluate postoperative state and prognosis of the 5 cases that underwent the posterior spinal fixation surgery for vertebral metastasis in advanced lung cancer.

      Results
      5 patients were underwent this surgery, 3 were male and 2 were female and the average age was 58.9 years. We added the surgery to remove the pressure of the spine in 3 cases, fortunately there was no spinal invasion in these 5 cases. We preformed chemoradiotherapy in 4 cases and chemotherapy alone in 1 case. EGFR mutation was positive in 2 cases. All patients were possible to ambulate in early postoperative day, and they showed improvement of neurological symptoms of paralysis. It was possible to maintain a relatively well ADL.

      Conclusion
      There may be an excessive burden to perform the surgery for the patients with vertebral metastasis in advanced lung cancer, the surgery for selecting patients may have been able to improve neurological symptoms such as paralysis. Therefore, we thought that the surgical procedure for the patients who are possible to survive long term period might have been one of the important treatment methods because of maintaining possibly their ADL well.

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    P3.07 - Poster Session 3 - Surgery (ID 193)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P3.07-033 - Surgical treatments for NSCLC of female patients under 50 years old (ID 2704)

      09:30 - 16:30  |  Author(s): J. Hanaoka

      • Abstract

      Background
      The number of patients with non-small cell lung cancer (NSCLC) has been increasing for some decades. The patients are predominantly male and over 50 years old in age, whereas female patients under 50 years old are relatively small cohort in NSCLC. Therefore, the characteristics of these female patients remain to be unclear.

      Methods
      In this study, we examined the clinico-pathological characteristics of female patients under 50 years old who had received surgical treatments for NSCLC. Female patients who had been under 50 years old and received curative surgical resection for NSCLC in our hospital from January 2000 to December 2010 were involved in this study. The clinico-pathological characteristics of them were examined retrospectively and compared with those of relative male patients in the similar criteria. Both overall survival (OS) and disease-free survival (DFS) times after surgery were obtained by Kaplan-Meier analysis, and differences between two cohorts were analyzed by log-lank test.

      Results
      In total, 13 female patients with median age of 43 years old (range: 40-49 years old) and 12 male patients with median age of 43years old (range: 31-49 years old) were received curative surgical resection for NSCLC in this period. All of the female patients were never-smokers, whereas 11 male patients (91.7%) were current smokers. Twelve female patients were free from symptoms at the diagnosis of NSCLC, however, 5 male patients had some symptoms related to NSCLC (a rate of symptom-free patients; female vs male = 92.3% vs 58.3%). Pathological stages of female NSCLC were as follows; 1A: 9, 1B: 1, 2A: 1, 3A: 1, 3B: 1. All cases of female NSCLC (100.0%) were diagnosed with adenocarcinomas histologically; mixed subtype: 6, papillary: 2, bronchiolo-alveolar cell carcinomas (BAC): 5 cases. In males, 8 patients (66.7%) were diagnosed with adenocarcinomas including 1 BAC case. The rates of OS and DFS at 5 years after surgery of female patients were 100.0% and 74.6%, respectively, with the median observation period was 69.0 months (range: 17-148 months). On the other hand, the rates of OS and DFS at 5 years after surgery of male patients were 74.6% and 58.3%, respectively, demonstrating that OS in female patients seemed to be long as compared with that in male patients (P=0.302).

      Conclusion
      More patients who were free from symptoms, never-smokers and with BAC subtype were included in female than male patients in this study. These characteristics of female patients would have contributed to the better prognosis of them after surgery. In the NSCLC patients under 50 years old, the prognosis of female patients who received curative surgery is likely to be better than that of male patients.