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N. Girard



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    MINI 17 - WT EGFR, Angiogenesis and OMD (ID 131)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      MINI17.04 - Erlotinib in 2nd Line in Advanced Squamous NSCLC: Final Results of the Pepita Cohort (ID 822)

      16:45 - 18:15  |  Author(s): N. Girard

      • Abstract
      • Slides

      Background:
      Erlotinib in 2[nd] line improves survival in patients with recurrent/progressive NSCLC, is also active in squamous cell NSCLC, as reported in a BR.21 study subgroup. So far, no prospective non interventional study has specifically evaluated patients with this histological subtype treated with erlotinib. We present the final results of PEPITA cohort.

      Methods:
      PEPITA is a French multicenter, prospective cohort study assessing erlotinib modalities of use in daily practice in squamous NSCLC. The primary endpoint was progression-free survival (PFS); secondary endpoints included patients’ characteristics, overall survival (OS), safety and quality of life. EGFR mutation was tested in 41 patients (28.5%) reason why exploratory analyses assessing EGFR genotyping and smoking status were also performed.

      Results:
      Between June 2012 - May 2013, 152 patients were included and 146 patients were analyzed for efficacy; median follow-up was 5.31 months (0.03-17.65).

      Patients characteristics at baseline Efficacy population (n=146) EGFR tested (n=41) EGFR not tested* (n=103) p-value
      Mean age (±SD), years Men 67.7 (±8.6) 90.4% 67.4 (±8.9) 87.8% 67.8 (±8.6) 92.2% 0.79 0.52
      ECOG PS 0/1 ECOG PS 2/3 17.5% / 43.8% 33.6% / 5.1% n=39 20.5% / 56.4% 23.1% / 0 n=96 16.7% / 38.5% 38.5% / 6.3% 0.09
      Current smoker Former smoker Never smoker 28.8% 63.7% 7.5% 24.4% 63.4% 12.2% 31.1% 63.1% 5.8% 0.39
      Comorbitities : Cardiovascular Endocrinological Pulmonary 63.0% 23.3% 19.9% 65.9% 22.0% 19.5% 62.1% 23.3% 20.4% 0.68 0.86 0.91
      * 2 patients without EGFR mutation status Efficacy and genotyping results were:
      EGFR mutation not tested n=103 EGFR mutation tested n=41 Non-smoker n=11 Smoker/Ex-smoker n=135 Efficacy population n=146
      PFS
      Event (progression or death) 95 (92.2%) 34 (82.9%) 8 (72.7%) 123 (91.1%) 131 (89.7%)
      Median (months) 2.8 [2.3;3.2]* 4.4 [2.9;5.8]* 3.3 [0.7;ND]* 3.0 [2.7;3.5]* 3.0 [2.7;3.5]*
      Survival rates at 12 months 7.0% [3.1;13.1]* 10.7% [3.1;23.6]* 27.3% [6.5;53.9]* 6.3% [2.9;11.6]* 8.0% [4.2;13.4]*
      OS
      Event (progression or death) 79 (76.7%) 22 (53.7%) 6 (54.5%) 96 (71.1%) 102 (69.9%)
      Median (months) 5.5 [4.0;6.4]* 9.1 [4.4;ND]* 8.0 [1.6;ND]* 5.8 [4.5;7.1]* 5.8 [4.7;7.1]*
      Survival rates at 12 months 22.4% [14.5;31.3]* 37.1% [20.9;53.5]* 43.6% [14.7;69.9]* 24.8% [17.2;33.0]* 26.3% [18.9;34.3]*
      *[95% CI] In the safety population (n=152 patients), 158 adverse events (AEs) were reported in 70 patients (46.1%), including 48 grade ≥ 3 AEs in 31 patients (20.4%). The most frequent AEs related to erlotinib were skin rash (all grades [23,7%], grade ≥ 3 [5,2%]) and diarrhea (all grades [11,8%], grade ≥ 3 [2.0%]); 19 serious adverse events (SAEs) were reported in 12 patients (7.9%), including 16 grade ≥ 3 SAEs in 10 patients (6.6%). There were 6 SAEs leading to death (3.9% patients), but none SAE was related to erlotinib.

      Conclusion:
      PEPITA is the first non-interventional study assessing modalities of use in daily practice of patients with stade IIIb/IV squamous NSCLC treated in 2[nd] line with erlotinib. This final analysis show similar efficacy and safety results to those observed in clinical trials. Clinical profile may drive EGFR genotyping.

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    MINI 25 - Trials, Radiation and Other (ID 142)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
    • Presentations: 2
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      MINI25.07 - Clinical Activity of Lucitanib in Advanced Thymic Epithelial Tumours (ID 2153)

      16:45 - 18:15  |  Author(s): N. Girard

      • Abstract
      • Presentation
      • Slides

      Background:
      Thymic epithelial tumours are rare malignancies for which there is no standard treatment for patients with advanced disease progressing on or after chemotherapy. Despite the lack of identified targets in thymic malignancies, several studies demonstrated that VEGFR and KIT pathways are the most relevant targets for therapeutic intervention. Lucitanib is an oral, potent, selective inhibitor of the tyrosine kinase activity of FGFR1-3, VEGFR1-3, and PDGFR α/β, all key targets involved in pro-angiogenic and proliferative pathways leading to tumour progression. Therefore, lucitanib could be a potential therapeutic alternative for patients with recurrent or refractory disease.

      Methods:
      This first in human study is currently evaluating oral lucitanib as monotherapy in various solid tumours. The escalation phase used a 3+3 design in patients with advanced solid tumours to establish the recommended phase II dose. Safety and efficacy were further evaluated in patients whose tumours were determined to be FGF aberrant (FGFR1 and/or 11q amplification) or in patients with tumours known to be anti-angiogenesis-sensitive such as thymic epithelial tumours. In addition, different doses and administration schedules were investigated.

      Results:
      Of the 134 patients treated in the study, 3 had B-type Thymoma (T) and 12 had Thymic Carcinoma (TC). Among these patients, median age was 54 years [range 37-72], 7 were males and 8 females. Twelve patients (80%) were treated at 12.5mg on daily basis. The other 3 patients (T) received 5, 15 and 20mg respectively. Patients had received a median of 2 previous anti-cancer treatments [range: 0-6]. Median duration of treatment with lucitanib was 7 cycles [range 2-44]. All patients were evaluable for anti-tumour activity according to RECIST v1.1. Two patients had confirmed partial response (1T / 1TC) lasting at least 7 months (TC patient is still ongoing) and 10 patients had a stable disease with 6 of them lasting at least 6 months. To date, 4 patients are still ongoing and receiving benefit from lucitanib independently of the number of previous regimens. The most common adverse events related to lucitanib in this population (all grades, all doses) were hypertension (80%), hypothyroidism (53%), proteinuria (53%) and diarrhoea (40%). There was no major bleeding event reported. These findings were in line with the overall safety profile of lucitanib already described.

      Conclusion:
      The results of this tumour cohort analysis suggest that lucitanib has signs of clinical activity in patients with advanced thymic epithelial tumours, and should be further investigated in dedicated studies.

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      MINI25.08 - Systemic Treatment in Advanced Thymic Epithelial Tumors. Insights From a Prospective Cohort of 888 Patients Enrolled in RYTHMIC (ID 1166)

      16:45 - 18:15  |  Author(s): N. Girard

      • Abstract
      • Slides

      Background:
      RYTHMIC (Réseau tumeurs THYMiques et Cancer) is the French nationwide network for thymic malignancies. Starting 2012, all patients diagnosed with thymic tumor had to be enrolled, as recommended by the French National Cancer Institute, part of good clinical practice.

      Methods:
      RYTHMIC prospective database is hosted by the French Thoracic Cancer Intergroup (IFCT), and collects clinical, imaging, treatment, and follow-up data of patients discussed at the reference national multidisciplinary tumor board (MTB). Data cutoff was April 1[st], 2015 for this analysis.

      Results:
      1089 questions were raised at the MTB about the management of 888 patients with thymic epithelial tumor. Among assessable cases, Masaoka-Koga stage III-IV tumors accounted for 42% of cases; histology was thymoma in 82% of cases, and thymic carcinoma in 18% of cases. First-line treatment of locally advanced disease, and management (diagnosis and treatment) of recurrent disease led to raise 227 (21%), and 234 (21%) questions at the MTB, respectively, 312 (68%) of which were about the modalities of systemic treatment. Figure 2 shows the proposed regimens for primary (A) and exclusive (B) chemotherapy in treatment-naïve patients, and chemotherapy (C) and targeted agents (D) for recurrent tumors. Combination of cisplatin, adriamycin, and cyclophosphamide and carboplatine, paclitaxel were the most frequently proposed regimens as first- and second-line treatment, respectively. Figure 1 Figure 2





      Conclusion:
      RYTHMIC is an exhaustive registry of thymic malignancies, which provides unique insights in the management of advanced and recurrent tumors with systemic agents. Meanwhile, limited data have been made available in the literature so far, as clinical trials were conducted in small numbers of patients, and existing databases enrolled a majority of surgically resected, early-stage tumors. Through the use of targeted agents, RYTHMIC allows the rapid implementation of new results in clinical practice, while ensuring patients an equal access to therapeutic innovation. Supported by Institut National du Cancer

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    MINI 33 - Radiotherapy and Complications (ID 164)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      MINI33.06 - Prospective Monitoring of Lung Function Test with CO and NO Diffusion during Thoracic Radiotherapy: Preliminary Results of the CONORT Study (ID 2402)

      18:30 - 20:00  |  Author(s): N. Girard

      • Abstract
      • Presentation
      • Slides

      Background:
      Thoracic radiotherapy is a usual treatment for lung cancer; either at early-stages (stereotactic mode) or at locally advanced stages (conventional radiotherapy mode). Thoracic irradiation appears to have little impact on lung volume such as forced expiratory volume in one second (FEV1) or forced vital capacity (FCV). By contrast, carbon monoxide diffusing capacity (TLCO) may be altered under thoracic radiotherapy. Pulmonary diffusion may be also evaluated by the NO (azote monoxide) diffusion capacity (TLNO). Moreover, double assessment of NO and CO diffusing capacities open the way to understand if alteration of lung diffusion is due to alveolar membrane and/or a pulmonary capillary alteration. CONORT aims at measuring pulmonary function tests (PFTs), in particular the CO and NO diffusing capacity, during thoracic radiotherapy.

      Methods:
      Prospective multicenter study. CONORT study was approved by the Lyon Sud-Est IV ethics committee and the database was declared to the national information registry authority as required by French laws. Overall 112 patients must be included to estimate a difference of 15% in diffusing capacity test, with a 90% power and a 5% alpha risk. All consecutive patients treated by thoracic radiotherapy in Lyon Sud Hospital were included regardless of histology and radiotherapy technique. PFTs including double diffusion are performed by the same operator and using the same technic, before-, during-, at the end-, six weeks after- and six months after- thoracic irradiation. All included patients gave their consent. Results at PFTs were expressed in % of theoretical value (%th), and were compared using Student t test.

      Results:
      Between 1[st] February 2014 and 14 April 2015, 88 patients were included and 62 have been analyzed. Patients were male in 73%, mean age was 67.4 years. Radiotherapy technique was intensity-modulated radiation therapy (IMRT) in 61%, stereotactic radiotherapy (SBRT) in 32%, and 3D conformal radiotherapy in 7%. Mean pretreatment FEV1 was 2.06L (78.9% of the standard), mean FCV was 3.17L (94.9%), mean TLCO was 16.5 (64.7%) and mean TLNO was 72.7 (60.3%). FEV1 and FCV were stable during and after radiotherapy. However, mean TLCO decreased by 4.4% (P=0.01) between first and fourth PFT, mean DLNO decreased by 4% (P=0.001) between first and second PFT, mean VC (capillary lung volume) decreased by 6.24% between first and fourth PFT (P=0.011), and DM (membrane diffusing capacity) decreased by 3.6% between first and second PFT (P=0.001).

      Conclusion:
      CONORT is the first study evaluating the potential impact of thoracic radiotherapy on double measurement of lung diffusing capacity. These preliminary results showed that thoracic radiotherapy has little impact on lung volumes. However, lung diffusion decreases, initially by membrane alteration and then by capillary alteration. Results at 6 months showed that this alteration is fully recovered. Updated data will be presented at meeting.

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    MTE 13 - Standard of Care in Rare Thoracic Malignancies (Ticketed Session) (ID 65)

    • Event: WCLC 2015
    • Type: Meet the Expert (Ticketed Session)
    • Track: Community Practice
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2015, 07:00 - 08:00, 105
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      MTE13.01 - Standard of Care in Rare Thoracic Malignancies (ID 1998)

      07:00 - 08:00  |  Author(s): N. Girard

      • Abstract
      • Presentation
      • Slides

      Abstract:
      Thymic malignancies represent a heterogeneous group of rare thoracic cancers [1, 2]. The histopathological classification distinguishes thymomas from thymic carcinomas. Thymomas are further subdivided into different types (so-called A, AB, B1, B2, and B3) based upon the atypia of tumor cells, the relative proportion of the associated non-tumoral lymphocytic component, and resemblance to the normal thymic architecture [3]. Thymic carcinomas are similar to their extra-thymic counterpart, the most frequent subtype being squamous cell carcinoma. The diagnosis of any thymic epithelial tumour relies on making the differential diagnosis with other anterior mediastinal tumours and non-malignant thymic lesions. Thymic epithelial tumours are routinely staged according to the Masaoka-Koga staging system, which is correlated with overall survival. Masaoka-Koga staging is a surgical pathology system that is assessable only after surgical resection of the tumour [4]. Recently, the International Association for the Study of Lung Cancer (IASLC) Staging Prognostic Factors Committee, together with the International Thymic Malignancy Interest Group (ITMIG), proposed a Tumour-Node-Metastasis (TNM)-based staging system for thymic malignancies, based on overall survival analyses of a retrospective international database of more than 10,000 cases [5]. The TNM-based approach has the advantage of being more appropriate both for thymoma and thymic carcinomas, which present with a higher propensity towards nodal and distant metastatic invasion. The management of thymic epithelial tumours is a paradigm of multidisciplinary collaboration. Systematic immunological check-up is recommended when a diagnosis of thymic epithelial tumour is suspected, including complete blood cells count with reticulocytes and serum protein electrophoresis, as well as anti-acetylcholine receptor and antinuclear antibodies tests. This is to make the diagnosis of the most frequent immune disorders associated with thymoma, the most frequent being myasthenia gravis, that may impact any therapeutic intervention, including surgery, radiotherapy, and chemotherapy. The treatment strategy is based on the resectability of the tumour [6]. The assessment of resectability is mostly based on the surgeon’s expertise; it is recommended to discuss indications for surgery in a multidisciplinary tumour board setting. The new TNM staging may even better help to formalize resectability: T1-3 level of invasion refers to structures amenable to surgical resection, when T4 level of invasion includes unresectable structures. If complete resection is deemed to be achievable upfront, as it is the case in Masaoka-Koga stage I/II and some stage III tumours, surgery represents the first step of the treatment, possibly followed by postoperative radiotherapy, and for carcinomas, chemotherapy. Standard approach is median sternotomy; minimally-invasive surgery is an option for presumed stage I and possibly stage II tumours in the hands of appropriately-trained thoracic surgeons. Current practices for postoperative radiotherapy are highly variable and there is paucity of prospective, multicentre evidence. The global trend over the past years has been towards a less frequent use of postoperative radiotherapy in thymoma, and to keep it in reserve for high-risk cases. This is based on recent reports from large databases, as well as pooled analyses of retrospective studies, indicating: 1) the absence of survival benefit after radiotherapy in stage I thymoma, or after R0/1 resection of stage II-III thymoma; 2) a similar rate of recurrence in patients who received postoperative radiotherapy or not after complete resection of thymoma; and 3) a recurrence-free and overall survival benefit with postoperative radiotherapy after resection of thymic carcinoma. If complete resection is deemed not to be achievable upfront on the basis of imaging studies, as it is frequently the case in Masaoka-Koga stage III/IVA tumours, a biopsy should be taken, followed by primary/induction chemotherapy as part of a curative-intent sequential strategy that integrates subsequent surgery or radiotherapy. Patients not eligible for local treatment receive palliative chemotherapy only. Cisplatin-based combination regimens should be administered; combinations of cisplatin, adriamycin and cyclophosphamide, and cisplatin and etoposide, are the recommended options [7]. Primary chemoradiotherapy with platin and etoposide is an option for thymic carcinomas. Innovative options may include KIT sequencing in the setting of potential access to specific inhibitors, particularly clinical trials; sunitinib may represent an off-label option as second-line treatment for thymic carcinomas, independently from KIT status, through antiangiogenic effects [8]. mTOR is emerging as a potential target in thymic epithelial tumours, following tumour responses observed in phase I-II trials. Ongoing trials are assessing immune checkpoint inhibitors for refractory thymic carcinoma. No prospective data are available to build recommendations about post-treatment oncological follow-up of patients. Follow-up may be continued for 10-15 years given the possible occurrence of late recurrences. Clinicians should be aware of the possible late onset of new autoimmune disorders. REFERENCES 1. Girard N, Mornex F, Van Houtte P, Cordier JF, van Schil P. Thymoma: a focus on current therapeutic management. J Thorac Oncol 2009;4:119-126. 2. Girard N, Ruffini E, Marx A, Faivre-Finn C, Peters S; ESMO Guidelines Committee. Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; in press 3. Marx A, Ströbel P, Badve SS, et al. ITMIG consensus statement on the use of the WHO histological classification of thymoma and thymic carcinoma: refined definitions, histological criteria, and reporting. J Thorac Oncol. 2014;9:596-611. 4. Detterbeck F, Nicholson AG, Kondo K, et al. The Masaoka-Koga Stage Classification for Thymic Malignancies: Clarification and Definition of Terms. J Thoracic Oncol 2011; 6:S1710-6. 5. Detterbeck FC, Stratton K, Giroux D, et al; Staging and Prognostic Factors Committee; Members of the Advisory Boards; Participating Institutions of the Thymic Domain. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol 2014;9:S65-72. 6. Detterbeck FC, Moran C, Huang J, et al. Which Way is Up? Policies and Procedures for Surgeons and Pathologists Regarding Resection Specimens of Thymic Malignancy. J Thoracic Oncol 2011;6:S1730-1738. 7. Girard M, Lal R, Wakelee H, et al. Chemotherapy definitions and policies for thymic malignancies. J Thorac Oncol 2011;6: S1749-1755. 8. Rajan A, Girard N, Marx A. State of the art of genetic alterations in thymic epithelial tumors. J Thorac Oncol 2014;9:S131-136

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    ORAL 03 - New Kinase Targets (ID 89)

    • Event: WCLC 2015
    • Type: Oral Session
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      ORAL03.06 - Activity of Crizotinib in MET Amplified NSCLC: Preliminary Results of the AcSé Trial (ID 1200)

      10:45 - 12:15  |  Author(s): N. Girard

      • Abstract
      • Presentation
      • Slides

      Background:
      Crizotinib (crz) is registered only for the treatment of patients (pts) with ALK-translocated lung cancer. Crz is also a MET inhibitor. MET is amplified in several malignancies. Activity of crz in MET amplified (+) tumors was explored as part of the French National Cancer Institute (INCa) AcSé program, including both access to tumor molecular diagnosis and an exploratory multi-tumor 2-stage design phase II trial. We report here results in pts with MET + NSCLC.

      Methods:
      MET analysis on formalin-fixed, paraffin-embedded tumor samples was proposed in 170 investigating centers and performed in 28 regional INCa molecular genetic centers. MET+ was explored by FISH in tumor samples showing an IHC score of ≥2+. Pts with a tumor showing > 6 MET copies, whatever the MET/CEN7 ratio, were eligible, providing they were not eligible for any other academic or industry trial evaluating another MET inhibitor. Study treatment consisted in crz 250 mg BID. The objective response rate (ORR) and disease control rate (DCR) were assessed every 8 weeks, using RECIST v1.1.

      Results:
      From Aug. 5, 2013 to Mar. 1, 2015, 25 pts with MET+ NSCLC were enrolled and received crz. Median age was 59 years (range 30–92). Forty-four percent were females, 92% had tumors of non-squamous histology, and 96% presented with metastatic disease at study entry. Median number of prior treatments was 2 (range 0 – 11). Eight pts were still on treatment at the cut-off date, 17 have stopped crz (15 progressive diseases (PD), 1 adverse event (AE), 1 patient’s choice). Among the 18 pts evaluable for response after 8 weeks, we observed 7 partial responses, 6 stable diseases and 5 PD, leading to an ORR of 39% [95% CI:17-64], and a DCR of72% [47-90]. DCR at 6 months was 22% (4 pts out of the 18 evaluable pts). Crz was well tolerated with only 5 grade ≥3 (2 AE + 3 SAEs) and 3 grade 1-2 SAEs. Most common AEs, mainly grade 1 or 2, were nausea (60% of pts), visual disorders (52%), anemia (52%), elevated transaminases (48%) and vomiting (40%).

      Conclusion:
      Nationwide biomarker-driven access to crz for pts with MET+ malignancy is feasible. Crz was well tolerated and showed responses in pretreated MET+ lung cancers. Survival data and duration of response will be presented.

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    ORAL 11 - Clinical Trials 1 (ID 100)

    • Event: WCLC 2015
    • Type: Oral Session
    • Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
    • Presentations: 1
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      ORAL11.08 - Discussant for ORAL11.05, ORAL11.06, ORAL11.07 (ID 3473)

      10:45 - 12:15  |  Author(s): N. Girard

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    P1.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 224)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
    • Presentations: 1
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      P1.08-035 - Pan-European Survey on Thymic Malignancies: A Collaboration of the EORTC Lung Cancer Group (LCG) with the RYTHMIC Network (ID 690)

      09:30 - 17:00  |  Author(s): N. Girard

      • Abstract
      • Slides

      Background:
      Thymic malignancies are rare tumors with an incidence of over 0.15 cases per 100.000 persons/year. Because of the indolent course and sporadic occurrence, the management of this disease has been mainly based on single-institution retrospective, observational studies. Clinical trials have been run in the recent years but no uniformly accepted guidelines are available so far. For advanced disease at diagnosis or with relapse/ progression treatment options are limited in first line and there is no standard treatment for second line treatment. The EORTC Lung Cancer Group (LCG) and French RYTHMIC network developed a survey with the aim of assessing the current treatment strategies and respective outcomes, thus providing an overview on the management of these tumors in advanced stage.

      Methods:
      We conducted a 25-item survey disseminated as dedicated mailing in the EORTC LCG and RYTHMIC network. Descriptive statistical analysis was applied to assess and present the preliminary replies.

      Results:
      At the time of the analysis, a total of 45 physicians from 11 countries participated in the study, the majority of participants were EORTC members (60.8%) and 11.1% were both EORTC and RYTHMIC members. About half of the institutions have a dedicate team for thymic malignancies (46.7%) but almost all of them have in place multidisciplinary meeting to discuss new diagnosed patients (91.1%).Diagnosis is made on surgical sample in 53.4% of the cases flowed by core needle biopsy (33.6%) and open biopsy (13%). For both thymoma and thymic carcinoma, the preferred choice for induction chemotherapy is CAP (cisplatin, doxorubicin and cyclophosphamide) (42.2% and 31.1% respectively) followed by cisplatin and etoposide (13.3% and 13.3% respectively). Also for first line chemotherapy, for both thymoma and thymic carcinoma, the preferred choice is CAP (35.6% and 28.9% respectively). For first line treatment the reported Overall Response Rate (ORR) is about 40% for thymoma and 31% for thymic carcinoma, the median Progression Free Survival (PFS) is 8 months for thymoma and 3 months for thymic carcinoma and the reported median Overall Survival (OS) is 28 months for thymoma and 18 months for thymic carcinoma. For both thymoma and thymic carcinoma, the preferred first choice for second line chemotherapy is carboplatin and paclitaxel (35.6% and 31.1% respectively) and the prefered second choice is cisplatin and etoposide (13.3 and 17.8% respectively). For second line treatment the reported ORR is about 36% for thymoma and 23% for thymic carcinoma, the median reported PFS is 8 months for thymoma and 4 months for thymic carcinoma; the median OS is 15 months for thymoma and 9 months for thymic carcinoma. No testing for c-kit or EGFR mutations is routinely performed.

      Conclusion:
      The survey provides a large, multi-institutional overview of the clinical practice in the management of thymic tumors in Europe, and provides relevant and updated background for the development of future collaborative trials. The survey is still ongoing and final results will be presented at the conference.

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    P2.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 225)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
    • Presentations: 1
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      P2.08-030 - Sunitinib in Patients with Advanced Thymoma and Thymic Carcinoma. Retrospective Analysis from RYTHMIC Database (ID 1160)

      09:30 - 17:00  |  Author(s): N. Girard

      • Abstract
      • Slides

      Background:
      Sunitinib is a potent oral tyrosine kinase inhibitor of VEGFR, KIT and PDGFR. In a single arm phase 2 study of sunitinib after at least one previous line of chemotherapy, a 26% of partial response rate (PR) was reported in thymic carcinoma (TC) and 6% in thymoma (T), with a median progression free survival (mPFS) of 7.2 months and 8.5 months, respectively. We investigated if off-labelled prescription of sunitinib in this population induced the same efficacy signal.

      Methods:
      We investigated the database of the French thymic malignancies network. We reviewed advanced T and TC patients (p) who were treated with sunitinib in order to evaluate patient’s outcome.

      Results:
      From October 2011 to January 2015, 28 patients of 7 institutions were identified (20 TC and 8 T). 32% of patients were females and median age was 49.7 y. Fifteen patients (54%) received sunitinib in ≥ 4[th] line of treatment. Two patients received sunitinib in 1[st] line treatment (1 T and 1 TC). The 37.5 mg was the initial dose of sunitinib in 16p. In the whole population, the PR rate was 21% (of 20p with TC, 4 (20%) had a PR; and of 8p with T, 2 (25%) had partial responses). Of note, PR to sunitinib was independent of treatment line (1p at 1[st] lines, 1p at 3[rd] line, 2 p at 4[th] line and 2p at ≥ 5[th] line). 3 TC p were c-KIT positive, without a clear relationship with response rate (1 PR, 2 PD). The mPFS in whole population was 103 days. For TC the mPFS was 87 days and 139 days for T. Sunitinib adverse events were manageable and tolerable. 8p stopped sunitinib due to toxicity. The median overall survival (OS) in the whole population was 175 days, with prolonged OS in T vs. TC (403 days vs. 166 days)

      Conclusion:
      Sunitinib is an active treatment in thymic epithelial malignancies irrespective of histological subtype, even in a heavy pre-treated population, and treatment line, supporting antiangiogenic therapies as an alternative treatment option for these patients.

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    P3.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 208)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P3.01-043 - Assessing Treatment Strategies for Lung Cancer in Octogenarians: Insights From a Cohort of 337 Patients (ID 1216)

      09:30 - 17:00  |  Author(s): N. Girard

      • Abstract
      • Slides

      Background:
      Aging increases the incidence of lung cancer in octogenarians. In this population, only limited data about treatment strategies and results are available, as those patients are usually not eligible for clinical trials; meanwhile, previously reported cohorts mostly focused on early-stage tumors. Our objective was then to provide a global picture of the treatment strategies for lung cancer in octogenerians, and to parallel those with available standards.

      Methods:
      Retrospective observational study of all consecutive patients aged 80 or more, with pathologically-confirmed lung cancer, and diagnosed at the Hospices Civils de Lyon between January 2005 and April 2014.

      Results:
      337 patients were included, 298 (88%) with non-small cell lung cancer (NSCLC), and 39 (12%) with small-cell lung cancer. For NSCLC, tumor was stage I, II, III, and IV in 10%, 9%, 25% et 57% of cases, respectively. Overall survival was 8.4 months. Geriatric assessment had been done only for 11% of patients. Overall, a standard treatment strategy - i.e. based on available recommendations and guidelines - was conducted for 42% of patients, while 24% received non-standard treatment, and 34% best supportive care only. At multivariate analysis, favorable prognostic factors on overall survival were performance status 0-1 (p<0.001), stage I/II (p<0.001), adenocarcinoma histology (p=0.026), and a standard treatment strategy (p<0.001). In the setting of metastatic NSCLC, 35% of patients received chemotherapy, the most frequent regimen being carboplatine and paclitaxel.

      Conclusion:
      Octogenarians with lung cancer are eligible for antitumor treatment in nearly 70% of cases, consisting of standard, recommended therapy in about half of the cases. Our data provide a unique overview of the management of octogenarians with lung cancer, to foster future prospective studies dedicated to this subset of patients.

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