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V. Ernani
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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: 1
- Moderators:J.M. Clavero, R. Hassan
- Coordinates: 9/08/2015, 16:45 - 18:15, 702+704+706
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MINI25.14 - Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH): Descriptive Analysis and Overall Survival (ID 3153)
16:45 - 18:15 | Author(s): V. Ernani
- Abstract
- Presentation
Background:
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare disorder characterized by proliferation of neuroendocrine cells in the bronchial wall and considered to be pre-invasive lesion for lung carcinoid tumors [1]. There is increasing rate of diagnosis of this condition due to widespread availability and use of cross sectional imaging. DIPNECH is reported as an incidental finding in approximately 5.4% of patients undergoing resection for lung neoplasms [2]. The optimal management of this condition is currently not well-established. The limited data regarding the clinicopathologic characteristics and long term outcome for patients with DIPNECH provided a strong rationale for this study.
Methods:
We employed medical records to obtain demographic, clinical characteristics and survival for patients diagnosed with DIPNECH at our institution between January 1990 to December 2014. A review of archival diagnostic material was conducted by expert pulmonary pathologists to confirm the original diagnosis. Differences in clinical characteristics and survival was assessed between patient groups defined by race, gender, age, smoking status, body habitus and treatment received. Survival was computed using the Kaplan–Meier method while univariate and multivariate models were employed to assess for significant association between patient survival and variables of interest.
Results:
A total of 27 patients were included in this analysis. The majority of patients were females (89%) and predominantly of Caucasian (66.7%) or Black (14.8%) race. The median age at diagnoses was 63 years (range: 20-77) and 61.5% of patients were non-smoker. Approximately 52% underwent surgical resection. The median overall survival (OS) was 151 months (95%CI: 39-165) while 1-year and 5-year survival rates were 95.2% and 73.2% respectively. Nineteen patients (71%) remain alive at the time of this analysis. Male patients (HR: 4.58, 95%CI: 0.76-27.67, p=0.098) and smokers (HR: 23.79; 95%CI: 0.98-579.54; p<0.052) appeared to have an inferior survival. No statistically significant difference in survival was recorded in patient subgroups defined by age, race, surgical intervention or body weight.
Conclusion:
DIPNECH is a rare condition with increasing rate of diagnosis. The overall prognosis is good in comparison to other lung neoplasms but up to a quarter of the patients do not survive beyond five years post diagnosis. Male gender and associated use of tobacco products may be associated with poor outcome. References: 1. Chassagnon, G., et al., DIPNECH: when to suggest this diagnosis on CT. Clin Radiol, 2015. 70(3): p. 317-25. 2. Ruffini, E., et al., The significance of associated pre-invasive lesions in patients resected for primary lung neoplasms. Eur J Cardiothorac Surg, 2004. 26(1): p. 165-72.
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P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 2
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.01-011 - Relationship between EGFR Mutation Status and Response to Specific Chemotherapeutic Agents in Patients with Stage IV Non-Small Cell Lung Cancer (ID 2491)
09:30 - 17:00 | Author(s): V. Ernani
- Abstract
Background:
The purpose of this study was to investigate whether outcomes with various chemotherapy regimens were affected by the specific epidermal growth factor receptor (EGFR) mutations in patients with stage IV non-small cell lung cancer (NSCLC).
Methods:
We retrospectively analyzed the association between the different EGFR mutations (exon 19 deletion, exon 21, and 18 mutations) and their response to chemotherapy. A total of 17 patients with stage IV NSCLC treated at Winship Cancer Institute of Emory University between January 2007 and February 2015 who received chemotherapy were investigated retrospectively, and their clinical date were assessed according to EFGR mutation.
Results:
14 (82.4%) females and 3 (17.6%) males were identified harboring EGFR mutations. Median age at the time of diagnosis was 66 years (SD 14.08). 12 patients (70.6%) were never smokers, and 5 (29.4%) were former or current smokers. EGFR exon 19 deletion was present in 7 patients (41.2%), exon 21 mutation in 8 (47.1%), and exon 18 in 2 (11.8%). 15 (88.2%) received chemotherapy, and 11 (64.7%) received pemetrexed-based treatment. Four patients had partial response (PR) as the best response to pemetrexed-based chemotherapy, and all of them harbored exon 21 mutation. Among patients that received other types of chemotherapies (paclitaxel, gemcitabine, navelbine and platinum), 6 with exon 21 mutation, and 2 with exon 19 deletion experienced PR. Progression-free survival (PFS) was not significantly different among the groups of mutation (p=0.3645) that received paclitaxel, gemcitabine, navelbine and platinum as chemotherapies, and PFS was also not different for pemetrexed-based regimen (p=0.4569).
Conclusion:
We did not find differential sensitivity to various chemotherapy agents based on mutation type in advanced NSCLC patients harboring an EGFR mutation.
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P2.01-068 - Androgen Deprivation Therapy for Prostate Cancer Associated with Improved Survival in Non Small Cell Lung Cancer: A SEER-MEDICARE Analysis (ID 2743)
09:30 - 17:00 | Author(s): V. Ernani
- Abstract
Background:
Cancer of the prostate and lung are most commonly diagnosed in the elderly. Aberrant female sex hormone signaling has been well-described in NSCLC. The impact of androgen deprivation therapy (ADT) on non-small cell lung cancer (NSCLC) outcome has, however, not been well studied.
Methods:
We employed the linked SEER-MEDICARE database to assess the potential impact of ADT on NSCLC. We analyzed data from patients diagnosed with NSCLC between 1985 and 2005 and registered in the SEER-MEDICARE database. Patients were categorized into three groups: prostate cancer diagnosis followed by NSCLC (PL), NSCLC followed by prostate cancer (LP) and NSCLC only (L). Demographic and survival outcomes were compared between these groups. The impact of sequence of cancer diagnosis and ADT on survival post NSCLC diagnosis was assessed within the PL group using logistic regression model. Cox proportional hazards models were employed to estimate the effect of ADT and stage of prostate cancer on survival with adjustment for significant prognostic factors.
Results:
A total of 417630 patients were included in this analysis; male/female (56.4%/43.6%); Race: White (84.0%), Black (9.0%), Asian (2.1%), Hispanic (1.0%), others (3.0%); Stage: I (17.4%), II (2.9%), III (33.6%) and IV (46.1%). The majority of the patients were in the L group (96.3%), followed by PL (2.9%) and LP (0.8%). Patients in the LP group had the best 12-month survival rates (84.5%), followed by L (44.4%) and PL (40.1%). Analysis within the PL group showed an inverse correlation between stage of prostate cancer diagnosis and interval of time to NSCLC diagnosis: 54.8, 54.1, 62.1 and 59.3 months for stage I, II, III and IV prostate cancer, respectively. Prostate cancer patients exposed to ADT had a shorter interval to lung cancer diagnosis (48.3 vs. 52.7 months; p < 0.001). On multivariate analysis, patients exposed to ADT had a higher median survival (10 months vs. 9 months; p < 0.001) and reduced risk of death (HR:1.11; 95%CI:1.05-1.18), p <0.001).
Conclusion:
ADT therapy for prostate cancer was associated with improved survival for subsequent NSCLC diagnosis. Our result supports systematic exploration of ADT as a treatment strategy for NSCLC.
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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
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.01-003 - Patterns of Disease Progression for Stage IV NSCLC While on PD-1 Directed Therapy as Compared to Standard Chemotherapy (ID 3052)
09:30 - 17:00 | Author(s): V. Ernani
- Abstract
Background:
Programmed Cell Death 1 (PD-1) inhibitor therapy is now an established therapeutic modality in certain solid malignancies, including non-small cell lung cancer (NSCLC). The purpose of this study is to determine whether disease progression patterns are different between PD-1 inhibitor therapy or chemotherapy in patients with advanced NSCLC.
Methods:
We performed a retrospective analysis of patients who received PD-1 targeted therapies and systemic chemotherapy for advanced NSCLC treated at the Winship Cancer Institute at Emory University. We reviewed demographic data and treatment history of these patients. RECIST criteria were used to evaluate the patients’ baseline tumor burden and their subsequent disease progression from imaging studies (CT, PET/CT, MRI).
Results:
The total cohort included 37 patients with a mean age of 67 years. The PD-1 therapy group included 19 patients (14 males, 5 females), with 9 on MK-3475, 3 on MDPL3280A, and 7 on nivolumab. This group included 3 African Americans and 16 Caucasians. The median number of lines of prior chemotherapy was 3. A comparator group of 18 patients on standard chemotherapy was identified (14 males, 4 females). This group included 8 African Americans and 10 Caucasians. In the PD-1 therapy group, 5 patients had no progression and 14 had disease progression. Of these, 5 progressed at their sites of known cancer (36%), 4 progressed at new sites (28.5%), and 5 progressed at both old and new sites (36%). In the chemotherapy group, 4 patients had no disease progression and 14 had progression. Of those 14, 2 were at old sites only (14%), 4 were at new sites only (29%), and 8 were at both old and new sites (57%). The median time to progression was 3.5 months with PD-1 targeted therapy (range 2-13 months) and 6 months with chemotherapy (range 2-21 months).
Conclusion:
Our data suggests no difference between the progression patterns between PD-1 inhibitor therapy and standard chemotherapy patients. Patients on PD-1 therapy appear to have a shorter time to progression than those on traditional chemotherapy.
