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M.E. Olmedo



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    MINI 11 - Tobacco Control and Prevention (ID 108)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Prevention and Tobacco Control
    • Presentations: 1
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      MINI11.12 - Is There Any Role for Residential Radon in Patients with Non Small Cell Lung Cancer (NSCLC) Harbouring Molecular Alterations? Preliminary Results (ID 993)

      16:45 - 18:15  |  Author(s): M.E. Olmedo

      • Abstract
      • Presentation
      • Slides

      Background:
      World Health Organization (WHO) recommends radon concentration lower than 100 Bq/m3. Previous studies have demonstrated the correlation between high level of residential radon exposure and lung cancer especially in non-smokers patients (p.). Similarly, most of the advances in personalized therapy in NSCLC p. also occurred in non-smoker. We hypothesized that residential radon could be associated to some specific molecular alterations in NSCLC p.

      Methods:
      A detector alpha-track was delivered to each p. to measure radon concentration in residence for 3 months and a questionnarie to fill out. The elegible population were NSCLC p. harbouring molecular alterations (EGFR, KRAS or BRAF mutations (m)), ALK or ROS1 rearrangements (r)) and non-smoker p. treated in the Medical Oncology Department, at Hospital Universitario Ramon y Cajal, Madrid. Incident cases and prevalent cases collected from lung cancer patients database have been included from September 2014 to March 2015. We collected demographic information, smoking history, environmental exposure and clinicopathological characteristics including histology, molecular profile, stage, treatment and survival. The radon concentration was analysed using optical microscopy with radosys system 2000. EGFR, KRAS, BRAF mutation (m) were analysed using quantitative real-time polymerase chain reaction (PCR) and ALK and ROS1 rearrangements by fluorescence in situ hybridization (FISH). Statistical analysis was performed using IBM SPSS.

      Results:
      So far now, 48 NSCLC adenocarcinoma p. have been enrolled although only 31 have already completed radon measurement. Median age 59 years (range 33- 82); 58,1% female; 77% ECOG 0; 74,4% stage IV; 90,3% living in Madrid. Smoking habits: non-smokers 58% (9p. EGFRm, 7p. ALKr, 2p. BRAFm), light smokers 6,45% (1p. EGFRm, 1p. ALKr) and heavy smokers 35,4% (6p. EGFRm, 5p. KRASm). Median pack-years: light smokers 2,5 (2-3), heavy smokers 44 (20-80). Non-smoker p. reported 27,8% passive-smoking exposure and 44,4% childhood exposure. Radon measurement characteristics: type of building 83.9% flat; building material: 87.1% bricks. Median time of permanence in the same house: 25 years (2-55). Median height of house 3 floors (0-6). Most of measurement at bedroom (93,5%). Median of radon concentration: 103 Bq/m3 (42- 852); 51.6% over WHO recommendation. By molecular alteration: EGFRm median 91 Bq/m3 (42-164), ALKr median 128 Bq/m3 (64-852), BRAFm median 125 Bq/m3, KRASm median 80 Bq/m3 (44-149). ALKr demonstrated association with levels higher than WHO recommendation (p=0.045 Fisher's exact test).

      Conclusion:
      Our preliminary results show that radon concentrations in NSCLC harbouring molecular alterations are higher than WHO recommendation, particularly in patients with ALK rearrangement. Final results will help to confirm this possible association.

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    P1.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 233)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Biology, Pathology, and Molecular Testing
    • Presentations: 1
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      P1.04-032 - Clinical and Pathological Characterization of Long-Term Survivors with Advanced Non-Small Cell Lung Cancer: A Multicenter Experience in Madrid (ID 378)

      09:30 - 17:00  |  Author(s): M.E. Olmedo

      • Abstract
      • Slides

      Background:
      Long-time survival is an important goal in NSCLC treatment. However, in patients (pts) with wild type EGFR and non translocated ALK (EGFRwt/ALKnt) advanced disease, median survival at diagnosis is around 9-14 months and long time survivors (LTS) constitute a very small proportion of these patients. The aim of our research was to explore the clinical-pathological characteristics of a population of EGFRwt/ALKnt LTS with an overall survival (OS) of at least 36 months, with the purpose to identify which clinical-pathological features could help to identify a better outcome in advanced NSCLC.

      Methods:
      We analyzed retrospectively data from patients diagnosed of EGFRwt/ALKnt advanced NSCLC with an OS of at least 36 months and treated in 8 institutions from Madrid (Spain). All these patients were selected in a period of 10 years (January 2002 to 2012). We analyzed clinical-pathological characteristics (age, sex, ECOG, stage IIIB vs IV, histology, smoking status, diabetes and vascular disease, weight loss >10%, symptoms at diagnosis and sites of metastasis), laboratory parameters (LDH and haemoglobin levels) and type of treatment administered (platinum based treatment, metasectomies, number of chemotherapy lines, maintenance, grade 4 toxicity as well as metformine intake). Finally, data from PFS and OS were also collected.

      Results:
      Among all patients diagnosed with EGFRwt/ALKnt NSCLC and treated in 8 institutions in 10 years, we identified 93 pts with an OS of at least 36 months. 55 pts (60%) were older 65 years, 67 pts (71%) male and 85 pts (91 %) were smokers/former smokers. Comorbidities (diabetes and vascular disease) were infrequent: 7pts (7%) and 13 pts (14%), respectively. Adenocarcinoma was most common pathological subgroup (60 pts, 65%) followed by squamous (21 pts, 22%), large cell carcinoma (7, 7%) and “other histologies” (6 pts, 6%). The majority of them, had a good PS; ECOG 0 32 pts (34%) and 1 57 pts (61%). A minority of patients had weight loss greater than 10% at presentation (12 pts, 14%). Most frequent symptoms were cough (41 pts, 44%), followed by pain (34 pts, 36%), dyspnea (25 pts, 27%) and haemoptysis (9 pts, 9%). LDH and haemoglobin leves were normal in the majority (65 pts, 70% and 72 pts, 77%, respectively). On the other hand, metformin intake was uncommon (16 pts, 17%). One or two metastatic sites at diagnosis were described in 44 pts, 47% and 29 pts, 31%, respectively and only 13 pts (14%) had brain metastasis (mts) and 5 (5%) adrenal mts. First-line chemotherapy based in platinum was administrated in 92 pts (98%), however, maintenance therapy only in 41 pts (44%). Local treatment (metasectomies +/-RT), was done in 35 pts (38 %). Grade 4 toxicity was detected in 7 pts (7%). Finally, we estimated a median PFS of 13.4 months and median OS of 40.5 months

      Conclusion:
      To our knowledge, this is the largest multicenter serie reported of very long-term survivors (OS >36 months) with with EGFRwt/ALKnt advanced NSCLC. This study includes an exhaustive clinical and pathological analysis of this specific population. In this moment, we are carrying out a comprehensive molecular analysis

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