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M. Blake Cerda
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P1.06 - Poster Session with Presenters Present (ID 458)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.06-007 - Radical Treatment of Synchronous Oligometastatic Non-Small Cell Lung Cancer (NSCLC) (ID 6283)
14:30 - 15:45 | Author(s): M. Blake Cerda
- Abstract
Background:
Cancer represents a large biological spectrum of disease ranging from localized to multisystem involvement with multiple intermediate stages. Oligometastatic NSCLC is thought to carry a better overall survival (OS) but there are few prospective studies that evaluate it.
Methods:
Prospective cohort study with NSCLC patients treated at the Instituto Nacional de Cancerologia of Mexico, with stage IV and oligometastatic disease (≤ 5 metastatic lesions). Patients were enrolled to receive, after 4 cycles of systemic treatment with platinum-doublet chemotherapy or 4 months of tyrosine kinase inhibitors in patients with driver mutations, local consolidative treatment for the primary lesion and their metastases with chemoradiotherapy, surgery, radiotherapy, stereotactic radiosurgery or radiofrequency ablation based on the decision of the Multidisciplinary Thoracic Committee of the institution. The primary outcome was overall survival. The study was approved by de Institutional Ethics Committee and registered in clinical trials NCT02805530.
Results:
Up to this moment, we have evaluated 29 patients with NSCLC and oligometastatic disease. Of these, 62% males with a median age of 58 years (IQR 52.5-64.5), median CEA 10.2 (IQR 3.25-55), 59% former or currently smokers (median 37.5 package/year), wood-smoke exposure 28%. Overall 90% of the patients presented adenocarcinomas, 28% EGFR mutation (50% deletion of exon 19, 38% mutation on exon 21). At diagnosis 93% of the patients had symptoms mainly cough (48%), dyspnea (30%), neurologic symptoms (26%), weight loss (18%) and dysphonia (15%). We evaluated the oligometastatic disease status with PET-CT and MRI in 66% of the patients and the remaining with CT scan plus MRI. At diagnosis 66% had one or two metastases, 14% three to four metastases and 20% five metastases. For metastatic sites CNS was the main site of metastases in 52% of patients, 28% contralateral lung, 17% bone metastases and 7% at suprarenal. For radical treatment to the primary tumor, 59% chemoradiotherapy, 21% radiotherapy, 28% surgery and 3% radiofrequency. For definite treatment for the metastases, 45% received radiotherapy, 14% chemoradiotherapy and 17% surgery. The mean dose of radiotherapy received for the control of the primary tumor was 56.3 Gy (SD 11.28 Gy) and 29.5 Gy (SD 3.84Gy) for metastases. After multimodal treatment 24% had radiologic complete response. The median OS were 18.26 months (95%CI:10.89-25.64), the median OS for those with and without radiologic complete response were 28.58 months (95%CI:12.98-44.18) and 14.45 months (95%CI:10.40-18.51) respectively.
Conclusion:
Patients with oligometastatic NSCLC with agressive treatment have a large OS regardless their mutational status.
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P2.02 - Poster Session with Presenters Present (ID 462)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-062 - Alterations in Pulmonary Function Tests Predict the Development of Radiation-Induced Pneumonitis in Advanced NSCLC (ID 4948)
14:30 - 15:45 | Author(s): M. Blake Cerda
- Abstract
Background:
Chemo and radiation therapy are the standard of treatment in patients with locally advanced NSCLC. Radiation pneumonitis is a frequent complication and its presence is associated with severe symptoms that decrease the quality of life and might result in pulmonary fibrosis or death.
Methods:
Prospective study from June 2013 to July 2015, in patients treated with concurrent chemoradiation for NSCLC at the Instituto Nacional de Cancerología of Mexico. All patients had pulmonary assessment at baseline (prior to chemoradiation) and at 6 weeks, 3, 6 and 12 months (end of chemoradiation). The pulmonary function tests (PFT) included: spirometry, pletismography, oscilometry, diffusing capacity for CO2, molar mass of CO2, arterial gasometry, 6 minutes walk and fraction of exhaled NO (FENO). Radiation pneumonitis was evaluated by RTOG criteria and the CTCAE V.4.0. The study was approved by the ethics committee and was registered in clinicaltrials.gov (NCT01580579).
Results:
Overall 52 patients were included and 37 patients completed one-year follow-up. Severe pneumonitis developed in 11/37 (29%) and 15/37 (40%), according to the RTOG criteria and the CTCAE V.4.0, respectively. Factors associated with pneumonitis development included age and dose per fraction (>250cGy). We observed as well that patients who developed pneumonitis had more often central and lower tumors, and percentage of irradiated lung with 20Gy greater than 35% (PA V20>35%) and 5Gy over 65% (PA V5>65%). PFTs alterations prior to treatment that identified the development of severe pneumonitis included: a lower forced expiratory volume in one second after bronchodilator (FEV1, p= <0.02), ratio for the residual volume between total lung capacity (RV/FTA, p= < 0.02) and FENO (p= <0.04). All PFTs showed changes at the end of chemoradiation, particularly between the third and sixth month of treatment, with a slight recovery at 12 months, without returning to basal values. Although patients who developed pneumonitis had a greater deterioration in the spirometry and plethysmography, changes in PFTs during the first 12 weeks not predicted the development of pneumonitis.
Conclusion:
Alterations in FEV1, RV/TLC and FENO, prior to concomitant chemoradiation predict the development of severe pneumonitis in NSCLC. This study suggests that all patients who receive chemoradiation to the lung must be assessed by PFTs in order to identify patients at high risk for radiation pneumonitis, and have a close follow-up with an early start (beginning of symptoms) of steroids to reduce long-term complications.
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P2.03b - Poster Session with Presenters Present (ID 465)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.03b-003 - Mutation Profile & Histology According to ERS/ATC/IASCL Associated with IPFS to WBI in BM Patients with Recent Adenocarcinoma Lung Cancer (ID 5817)
14:30 - 15:45 | Author(s): M. Blake Cerda
- Abstract
Background:
Brain-metastases (BM) are a common metastatic site in non-small-cell lung cancer (NSCLC). We studied the impact of genetic alterations (EGFR, ALK and KRAS) in relation to objective response rate (ORR), intracranial-progression-free survival (IPFS) and overall-survival (OS) after whole-brain irradiation (WBI) in patients at recently diagnosis with NSCLC and BM.
Methods:
From 2009-2015, 231 NSCLC patients with BM were reviewed for eligibility. Among them, 121 patients with recently diagnosis of NSCLC, were treated with WBI and have available genotyping status.
Results:
EGFR, KRAS, ALK and WT patients were found in 38.0%, 6.6%, 5.8% and 49.6%, respectively. Overall, ORR and disease control rate (DCR) were 62.0% and 76.8%, respectively. ORR for EGFR, KRAS, ALK and WT patients were 82.6%, 25.0%, 71.4% and 50.0%, respectively (p=0.001). Female gender (OR 2.22 [95% CI: 1.01 – 4.89] P=0.047) and EGFR were associated to better response to WBI (OR 5.67 [95% CI 2.0-15.8], P = 0.001). A high architectural histological grade was independently associated with resistance to WBI. Median IPFS was 9.06 months [95% CI 6.5 -11.4]. IPFS for EGFR, K-RAS,ALK and WT patients were 11.9, 4.6,12.5 and 6.6 months, respectively (P <0.0001). EGFR mutation status (HR 0.54 [95%CI 0.3-0.9], P = 0.030) was the only factor associated with higher IPFS in the multivariate Cox-regression analysis. Median OS was 16.6 months [95% CI 11.6-22.6]. OS for EGFR, ALK, KRAS and WT patients were 26.8, 13.5, 4.9 and 13.6 months, respectively (P < 0.001). Intracranial OR was associated with a higher OS (HR 0.28 [95%CI 0.2-0.5], P < 0.001), while KRAS mutation positive status (HR 3.45 [95%CI 1.4-8.4], P = 0.006) was independently associated with worse OS. Figure 1
Conclusion:
EGFR mutation is an independent predictive factor for OR to WBI for BM in patients with NSCLC. KRAS mutation is an independent predictive factor for worse OS after BM.
