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L. Zhang



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    ORAL 29 - MASCC-IASLC Joint Session: Palliative and Supportive Care (ID 136)

    • Event: WCLC 2015
    • Type: Oral Session
    • Track: Palliative and Supportive Care
    • Presentations: 1
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      ORAL29.07 - Low Prognostic Nutritional Index Correlates with Worse Survival in Patients with Advanced NSCLC following EGFR-TKIs (ID 49)

      16:45 - 18:15  |  Author(s): L. Zhang

      • Abstract
      • Presentation
      • Slides

      Background:
      The systemic immunonutritional status has been postulated as related to the long-term prognosis in various cancer types. However, no studies have assessed the prognostic role of prognostic nutritional index (PNI) on the survival of patients with advanced non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR)-activating mutations and receiving tyrosine kinase inhibitors (TKIs).

      Methods:
      Advanced NSCLC patients with sensitive EGFR mutations (19 deletion or L858R in exon 21) were retrospectively screened. The PNI was calculated as 10 x serum albumin value (g/dl) + 0.005 x peripheral lymphocyte count (per mm3). Univariate and multivariate analysis were performed to assess the prognostic value of relevant parameters.

      Results:
      144 cases were included for analysis after eligibility review. The optimal cut-off value of PNI for OS stratification was determined as 48.78 according to a R software-engineered, web-based system. Low PNI was significantly associated with elevated CRP level (p<0.0001) and non-response to TKIs (p=0.002). High PNI (high vs low, 35.10 vs 25.67 months; HR, 0.44; 95 % CI, 0.25–0.77; p = 0.004) correlated to superior OS. Survival analysis identified PNI as an independent prognostic factor(p=0.012). Subgroup analysis revealed that PNI was generally a significant prognostic factor in different clinical situations.

      Conclusion:
      Low PNI correlates with worse survival in patients with advanced NSCLC harboring EGFR sensitive mutations and treated with EGFR-TKIs. The assessment of PNI could assist the identification of patients following EGFR-TKIs treatment with poor prognosis and has implications for the routine monitoring and treatment.

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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: 1
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      P2.01-063 - Dynamic Change of Fatigue for East-Asian Patients in the JMEN Trial (ID 843)

      09:30 - 17:00  |  Author(s): L. Zhang

      • Abstract

      Background:
      In the JMEN trial (Ciuleanu et al., Lancet 374:1432-1440, 2009), patients with advanced non-squamous non-small cell lung cancer (NSCLC) derived a benefit from pemetrexed maintenance therapy after platinum-based initial therapy by extending survival, delaying disease progression, and maintaining overall quality of life (QoL). However, fatigue was the most common physician-reported toxic effect in the pemetrexed treated group. We conducted a post-hoc analysis to investigate the dynamic change of fatigue in overall population and East-Asian (EA) patients treated on the JMEN trial.

      Methods:
      This analysis was performed in the overall safety population (N=656) and the EA subgroup safety population (N=152) mainly from China, Taiwan, and Korea including squamous and non-squamous NSCLC patients. The Common Terminology Criteria for Adverse Events (version 3.0) was used for summary of the AE incidence rates by cycle and AE severity reported by investigator. The Lung Cancer Symptom Scale (LCSS) was used to evaluate patients’ QoL. Worsening of fatigue was defined as an increase of 15 mm or more from baseline on a 100 mm scale in LCSS reported by the patients. The percentage of patients with worsening fatigue was also summarized by cycle. The time to worsening of fatigue symptom was analyzed using Kaplan-Meier method and Cox proportional model.

      Results:
      In the EA population drug-related fatigue (grade 1-4) occurred more frequently in pemetrexed arm compared with placebo arm (30.4% vs 16.0%, p=0.075). The grade 3/4 drug-related fatigue was rare in both arms (1 event reported in each arm). For both overall and EA populations, the fatigue incidence by cycle during the maintenance treatment with pemetrexed did not increase during subsequent cycles (Figure 1A, B). The percentage of patients who experienced worsening of fatigue based on the patients-reported LCSS scores was also comparable between the two arms in the overall and EA populations (Figure 1C, D). EA Patients in the pemetrexed arm experienced a numerically longer median time to worsening of fatigue compared to EA patients in the placebo arm, although the difference is not statistically significant (5.95 months vs. 3.91 months, HR= 0.84, 95% confidence interval [CI]: 0.51-1.37, p= 0.471). Figure 1



      Conclusion:
      These analyses suggest that despite a higher incidence of grade 1/2 drug-related fatigue compared with placebo, pemetrexed maintenance treatment for EA patients with advanced NSCLC will not impair patient-reported QoL.