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R.M. Gaafar
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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-054 - Biomarker Predictors in NSCLC (ID 5931)
14:30 - 15:45 | Author(s): R.M. Gaafar
- Abstract
Background:
Among the major challenges in the chemotherapeutic regimens is lacking of effective biomarkers for drug response and sensitivity. Our current study reviewed two promising biomarkers, ERCC1 (excision repair cross-complementing group 1) and RRM1 (ribonucleotide reductase group 1) to identify their potentiality to predict responder to Cisplatin and Gemcitabine among NSCLC (Non Small Cell Lung Cancer) patients.
Methods:
Prospectively, this study was conducted in National Cancer Institute (NCI) Cairo, Egypt. We measured the mRNA expression level of ERCC1 and RRM1 in tumor cells (using Real-time quantitative PCR) isolated from Stage IIIB/IV NSCLC patients planned to receive Cisplatin and Gemcitabine. Patients were divided into two groups, either both low ERCC1 and RRM1 (group 1)or both are high (group 2).Our objectives were the correlation between both groups and clinical response (CR), Progression free survival(PFS) and Overall Survival(OS).
Results:
Figure 1 55 patients were enrolled and followed from Jan 2011 to Jan 2014, Median age was 57(30-75years), 87% had ECOG-PS1, 86% had stage IV, responder(SD/PR) represented 56%. 30 patients had both low ERCC1 and RRM1 (group 1) while the rest 25 patients had high ERCC1 and RRM1 (group 2). There was no significant differences between different clinical response in both groups(P= 0.239), however multivariate Cox regression analysis revealed responders(p=0.007,HR0.33) and high ERCC1/RRM1 RNA (p=0.032, HR;2.51)to be the only predictors of overall survival. Patients in group 1 had longer median PFS (9.8 ms vs 4.9 ms, P= 0.001) and longer median OS (12.5 ms vs 6.2 ms, P<0.001) than patients in group 2.
Conclusion:
Low ERCC and RRM1 RNA levels serve as a guidance to predict chemosensitivity to cisplatin and Gemcitabine, with longer survival. Combination of ERCC1 and RRM1 RNA has a prognostic and predictive significance in Stage IIIB/IV NSCLC patients receiving Cisplatin and Gemcitabine. Large cohort studies are warranted.
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SC17 - Lung Cancer: A Global Cancer with Different Regional Challenges (ID 341)
- Event: WCLC 2016
- Type: Science Session
- Track: Regional Aspects/Health Policy/Public Health
- Presentations: 1
- Moderators:C. Vallejos, P.A. Bunn, Jr.
- Coordinates: 12/06/2016, 14:20 - 15:50, Strauss 1
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SC17.05 - Lung Cancer in Africa: Challenges and Perspectives (ID 6670)
14:20 - 15:50 | Author(s): R.M. Gaafar
- Abstract
- Presentation
Abstract:
Lung cancer has been the most common cancer in the world for several decades. The number of new cases estimated in 2012 is 1.8 million cases (12.9% of the total), 58% of which occurred in the less developed regions. The disease remains as the most common cancer in men worldwide (1.2 million, 16.7% of the total) with the highest estimated rates in Nothern America (33.8%) and Northern Europe (23.7%), a relatively high rate in Eastern Asia (19.2) and the lowest rates in Western and middle Africa (1.1 and 0.8 respectively). In developing countries, lung cancer is the most common cancer among males and the third most common cancer among females. Lung cancer is the most common cause of death from cancer worldwide estimated to be responsible for nearly one in 5 (1.59 million deaths, 19.4% of the total) (1). Temporal analyses reveal that significant reductions in lung cancer mortality have been observed in developed countries due to increased awareness of the harmful effects of smoking , asbestos and other factors The role of early detection is also evident. (2). In contrast, lung cancer incidence and mortality rates have increased in some low and medium resourced countries (3). The regional differences are mainly due to increased tobacco smoking in the developing countries , smoking waterpipe, cannabis or even passive and secondary smoke and in the mean time there is lack of proper tobacco control. There are also occupational risk factors such as asbestos exposure, dust, fumes, nickel ,silica and insecticides and up till now there are areas that have not banned asbestos or succeeded to control occupational and environmental exposure and incidence of mesothelioma is increasing. (4) Many studies have shown that cases have genetic susceptibility to develop lung cancer specially in North Africa. Another important factor specially the Middle East North Africa is the increase in the elderly population that may be attributed to better infection control and improvement of general health care . As life expectancy continues to increase throughout the African continent, the burden of cancer is likely to increase. Given that an estimated 32,640 new lung cancer cases will be seen in Africa in 2015 ( 5) .We have to remember also that cancer diagnosis rate in Africa is relatively low and patients present usually in an advanced stage so underreporting may be another factor . Accordingly, it is essential to know the magnitude of lung cancer in different regions in Africa by having cancer registry for the countries . So, obstacles to the global fight against lung cancer include lack of registry in some parts of Africa, low public awareness of lung cancer and absence of screening for the high risk cases , overburdened treatment centers and insufficient financial support. The ways to combat all these obstacles start by setting strategies for prevention and earlier detection in the low income countries. Public health awareness of the risk factors that cause lung cancer and the importance of avoiding / stopping smoking and banning asbestos should be clear and this is the role of public health authorities, medical journals and public media. The war against tobacco companies should start and everyone should understand the danger of smoking. This is done also by cooperation of scientific organizations of governmental and non governmental organizations. Also, we should reduce air pollution and regulate the occupational exposure of the employees to avoid the appearance of lung cancer and mesothelioma. As for early detection , screening can help in high risk patients and many authorities and NGOs can help to catch the early cases. In the mean time there should be ways to access modern imaging techniques to detect the cancer and use the minimal requirements for diagnosis and care . Accordingly it is essential to set the treatment guidance protocols to facilitate the management of the patients and to educate and train the doctors that should acquire degree granting programs and get certificates in the oncological field. It is mandatory to to lower the cost of health care to encourage the patients to go for treatment and to get the proper care. There should be special dealing for the economic pressure and avoidance of financial toxicities for the patient. The last point that have to be ameliorated in Africa developing countries is research through International collaboration as studying genetic polymorphism and relation to smoking and changing patient concept about drugs received in clinical trials that use new drugs, proper investigations and lower the cost of treatment and may get better outcome. References 1- Globocan 2012 (IARC): Estimated cancer incidence, mortality and prevalence worldwide, section of cancer surveillance 2- Jemal A, Center MM, DeSantis C, Ward EM (2010) Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 19: 1893-1907. 3- Sankaranarayanan R, Jayant K, Brenner H 2011: An overview of cancer survival in Africa, Asia, the Caribean and central America: the case for investment in cancer health services. IARC Sci Publ: 257-291. 4- Gaafar RM, Eldin NH (2005) Epidemic of mesothelioma in Egypt. Lung Cancer 49: S17-S20. 5- Tao Z, Shi A, Lu C, Song T, Zhang Z, etal. 2014: Breast cancer : Epidemiology and Etiology. Cell Biochem Biophysi
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