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Ana Caroline Zimmer Gelatti
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P1.01 - Advanced NSCLC (ID 757)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 2
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.01-043 - Molecular Testing for Non-Small Cell Lung Cancer in Latin American (ID 10391)
09:30 - 16:00 | Presenting Author(s): Ana Caroline Zimmer Gelatti
- Abstract
Background:
According to IALSC/CAP guidelines EGFR and ALK testing is recommended for all non-squamous advanced lung cancers. However, the real access to molecular test and treatment, especially in LATAN is unknown.
Method:
We conducted an online survey with medical oncologists from LATAN during May 2017. The survey has 20 questions about molecular test and target treatment, but also clinical practice in the management of advanced non-squamous NSCLC.
Result:
144 oncologists from 10 countries answer the survey, mostly of them (75%) from Brazil. Although 95% of the oncologists have access to EGFR mutation test and most of them can also test the ALK-fusion protein, only half of them test all patients. Usually these tests are supplied by the pharmaceutical industries (75% of EGFR and 78% of ALK). The mutation status are available in 2 weeks for the EGFR and in 3 weeks for the ALK. The main reason for not testing is lack of sufficient tissue (30% of oncologists), but also some difficulty in access and the long turn-around time where also an issue, 20% and 13% of the oncologist, respectively. Poor performance status and patient clinical characteristics were rarely considered a reason for not testing. Target therapy is available for mostly of the patients with private insurance, but only 50% in the public heath system have access to an anti-EGFR TKI and solely 20% can receive an anti-ALK TKI. New biopsies should be done in the progressive disease, but only 22% of the oncologists perform the procedure in more than 75% of their patient. Immunotherapy is a new treatment modality, especially in the develop countries, but it should be restricted as first line treatment to patients with high expression of PD-L1. In LATAN, immune checkpoints blockage is almost limited to the patients with private insurance (85%), being rare in the public heath system (15%). 83% of the oncologist considered to test the PD-L1 expression only after the results of EGFR /ALK are available.
Conclusion:
There are difficulties in the implementation of IALSC guidelines in LATAN. Mostly of the patients have access to EGFR mutation test, however the treatment is not available to everyone. It is clear the importance of the pharmaceutical industries in providing the molecular test by their voucher programs. The most important difficulty point out by the oncologists is the lack of tissue, but simple barriers as long time to get the results and access to the test should also be managed.
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P1.01-063 - Are the Real World Patients with Advanced Non-Small Cell Lung Cancer Represented in Phase III Immunotherapy Trials? (ID 9801)
09:30 - 16:00 | Presenting Author(s): Ana Caroline Zimmer Gelatti
- Abstract
Background:
Several randomized phase III trials with immune checkpoints inhibitors have accrued patients with metastatic non-small cell lung cancer (NSCLC). These trials employed strict patient selection criteria, and it is currently unknown how it represents the ‘real-world’ population.
Method:
From January 2011 to December 2016, all patients with metastatic NSCLC referred for first oncological evaluation at two University Hospitals in South of Brazil were identified by electronic database and included in the analysis. Twelve pre-defined eligibility criteria, all used in the recent first line phase III immunotherapy trial, were analyzed. OS and PFS were estimated by Kaplan-Meier curves. Multivariate analysis was performed to identify factors associated with survival. Statistical analysis was performed with SPSS 22.0.
Result:
Three hundred and nine patients were collected for this analysis. Patient characteristics revealed a mean age of 63.73 ± 09.47 years, 56% male and 65% had adenocarcinoma. One hundred ninety-seven (64%) patients did not meet one or more eligible criteria at first evaluation. ECOG performance status ≥2 (118 patients) and active brain metastasis (69 patients) accounted alone for 79.7% of non-eligibility cases. One hundred (50.76%), 53 (26.9%), 30 (15.22%) and 14 (7.1%) had 1, 2, 3 or 4 non-eligible criteria respectively. The median survival after the diagnosis of metastatic disease was 6.34 (95% IC, 5.59 to 7.08) months in the non-eligible group and 11.07 (95% IC, 8.65 to 13.48; p<0.001) in the eligible group. The hazard ratio of 1.90 (95% IC, 1.46 to 2.47) to mortality in the non-eligible group should reflect the worse baseline prognostic features in this group.
Conclusion:
To our knowledge, this is the first report of metastatic NSCLC patients analyzed regarding the eligible criteria of the phase III trials. It is clear that clinical trials do not represent the “real world” population and its outcomes have an important selection bias. Phase III clinical trials eligibility criteria should be reviewed to better represent the NSCLC population.
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P2.03 - Chemotherapy/Targeted Therapy (ID 704)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.03-029 - A Case of a Patient Harboring an EGFR Insertion of Exon 20 and Long Lasting Clinical Response to Afatinib (ID 9136)
09:30 - 16:00 | Presenting Author(s): Ana Caroline Zimmer Gelatti
- Abstract
Background:
Lung cancer remains a leading cause of mortality worldwide. Evolution in molecular biology has expanded and the identification of somatic mutations in the epidermal growth factor receptor (EGFR) as a clinically relevant oncogene also selected a subgroup of patients. Most commonly described as activating mutations, both deletion of exon 19 and L858R point mutation in exon 21 account for nearly 90% of all EGFR mutated patients. These patients usually benefit from tyrosine kinase inhibitors (TKIs). On the other hand, some patients harboring specific EGFR mutations – such as exon 20 insertions – do not benefit from the same strategy.
Method:
We describe a case report of a patient with advanced lung cancer. A female, 39-year-old patient was first diagnosed in late 2015 when she presented with dyspnea and lower back pain. Biopsy of the primary lung mass as well as a bone lytic lesion both revealed an adenocarcinoma. PET-CT showed extensive lymphangitic carcinomatosis, bone and cervical lymph node involvement. She underwent 5 cycles of cisplatin-pemetrexed with a good radiologic partial response and very good clinical response. During chemotherapy, the first molecular test (Cobas Z 480 Roche) became available showing an insertion of exon 20 in the EGFR gene.
Result:
Patient then requested an alternative treatment given that she was not inclined to accept maintenance with chemotherapy. We then proposed a short trial with afatinib, even though the chances of response were very low. She was started on afatinib PO 40mg/day on March 14[th,] 2016. Three weeks later the patient developed a grade 3 diarrhea and the drug was withheld until her symptoms resolved. She resumed afatinib PO at 30mg/day on April 20[th,] 2016. Her first radiologic evaluation two months later showed stable disease and she was kept on treatment and reported to feel healthier. Her second evaluation on November 2016 then showed a partial response, mainly in the bone and she was continued on oral TKI. New imaging studies on March 2017 revealed a progression of her disease only 12 months later.
Conclusion:
There is a lack of data addressing patients harboring rare and unique EGFR gene mutations. Most exon 20 insertions identified in patient samples have not been tested against reversible EGFR TKIs. Extrapolations from the few tested mutations might not apply for other exon 20 mutations. It is imperative that patient-derived cell lines of common EGFR exon 20 insertion mutations are developed to enhance our preclinical understanding on these tumors.
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P3.13 - Radiology/Staging/Screening (ID 729)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.13-018 - CT-Guided Percutaneous Barium Marking Prior to Video-Assisted Thoracoscopic Surgery (VATS) for the Localization of Small Pulmonary Nodules (ID 9497)
09:30 - 16:00 | Presenting Author(s): Ana Caroline Zimmer Gelatti
- Abstract
Background:
Widespread CT scan availability generates the challenge of managing small pulmonary lesions generally undetected on chest radiographs. Preoperative nodule localization is critical for adequate diagnosis and an accurate resection. Metallic hook wire localization under CT is a widely used method but can be associated with pneumothorax, hook related discomfort, and dislodgement. CT-guided percutaneous barium marking (CT-GPBM) can be simpler, low cost procedure, without risk of dislodgement, and radiopaque on fluoroscopy, increasing resection accuracy. Barium marking through bronchoscopy has been previously reported. This study describes our experience with CT-GPBM in the diagnosis and management of ground glass abnormalities and small pulmonary nodules.
Method:
Between January 2013 and May 2017, 36 patients underwent preoperative CT-GPBM and VATS resections at our institution, and were retrospectively reviewed. All cases were discussed in multidisciplinary rounds. After CT localization and local anesthesia, a 21-gauge Chiba needle was utilized, under CT guidance, to inject 0,2 mL of 140% barium sulfate suspension. A control CT confirms the marking and verifies possible complications. CT-GPBM and VATS resection are performed in the same day. VATS resection is performed under fluoroscopy guidance. Finally, the specimen is submitted to fluoroscopy to confirm a complete resection.
Result:
Thirty-six different cases were analyzed (41.7% male / 58.3% female). Median age was 65 (ranging from 32 to 91). 18/36 were never smokers. Most lesions were identified on routine follow-up CT (21/36 - 58.3%). Many had previous history of cancer (24/36 - 66.7%). 31/36 (86.1%) were single nodules - median size of 14mm (ranging from 5 to 47). Solid lesion was the most common radiologic finding (21/36 - 61,8%), while the others were semi-solid or ground glass abnormalities. Pathological findings confirmed primary lung cancer in 41,6% of cases (15/36). Adenocarcinoma was the most common histology. Nine patients had benign diseases. Metastatic lesions represented 33,3% (12/36), most derived from colorectal cancer. No patient had reported complications.
Conclusion:
This analysis shows that CT-GPBM is an effective, easy and safe pre-operative (VATS) localization procedure, allowing accurate diagnosis and resection of small or faint pulmonary nodules, avoiding thoracotomies in benign diseases and metastatic tumors. Data will be updated for presentation.
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P3.16 - Surgery (ID 732)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.16-034 - Impact of Travel Distance to Treatment Institution on Survival from Stage I to III Lung Cancer (ID 10350)
09:30 - 16:00 | Presenting Author(s): Ana Caroline Zimmer Gelatti
- Abstract
Background:
Over the last decade, attention and emphasis on regionalization of care for tertiary hospitals have increased in order to improve outcomes, especially in complex surgical procedures such as resection of lung cancer. On the other hand, the growing centralization of cancer services increases patient displacement and may delay access to specialized services and treatment. Impact of travel distance on patients’ outcome from lung cancer is poorly described. The objective of this study is to evaluate whether distance to treatment institution has an impact on survival from patients with lung cancer.
Method:
This is an observational, retrospective study, which included patients with stage I-III lung cancer that performed curative resection at Hospital São Lucas da PUCRS, Brazil. Data was collected from medical charts including demographic, clinical-pathological features and survival. Survival was estimated using the Kaplan-Meier method and log-rank test was used to perform multivariate analysis for prognostic factors. Chi-squared test was used to compare variables between groups.
Result:
Between January 2011 and December 2015, 234 patients with stage I-III lung cancer performed curative resection at Hospital São Lucas da PUCRS. The median age was 65 years (24-85 years) and 50.85% were male. 147 (62.82%) patients were from public health insurance and 87 (37.18%) had private coverage. The distribution of clinical stage ( AJCC 8th ed) was : 116 (49.57%) stage I, 71 (30.34%) stage II and 47 (20.09%) stage III. The median distance to institution was 19.7 (2-1086 km). Patients with public health insurance traveled higher distance than those with private coverage (p= 0.0004). The 3-year overall survival was 86.13% for stage I, 77.74% for stage II and 48.95% for stage III. The distance to institution had no impact in overall survival (p=0.85 for stage I, p= 0.63 for stage II and p= 0.46 for stage III).
Conclusion:
Our study shows that the distance between residence and treatment institution was not found to influence survival of the patients with lung cancer treated by surgery. Importantly, patients with public health insurance, which are in general poorer, have to travel longer distances for curative treatment.
