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F.Z. Caorsi
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P1.01 - Advanced NSCLC (ID 757)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- 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 | Author(s): F.Z. Caorsi
- 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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P1.06 - Epidemiology/Primary Prevention/Tobacco Control and Cessation (ID 692)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.06-007 - EGFR Status Evaluation and Epidemiological Profile in Patients with NSCLC in a Brazilian Public Health Instituition (ID 8657)
09:30 - 16:00 | Author(s): F.Z. Caorsi
- Abstract
Background:
Therapies targeting genetic alterations have improved response rates and overall survival for some patients with NSCLC (non small cell lung cancer) as agents against EGFR (epidermal growth factor receptor) actionable mutations. Is recommended to test all patients with advanced/metastatic non squamous NSCLC, but the rates of patients actually tested vary in different institiutions.The prevalence of EGFR mutations in non-squamous NSCLC population range from 15% to 40%. There is few data about EGFR mutations in the Brazilian population, which is known for ethnic heterogeneity. This study intends to report the rates of EGFR evaluation in advanced non-squamous NSCLC, as the prevalence and the profile of such mutations in a south brazilian public health instituition.
Method:
We performed an observational retrospective study including patients diagnosed with advanced non-squamous NSCLC between january 2011 to december 2016 at CEPON (Centro de Pesquisas Oncológicas). Their medical record have been reviewed and information regarding epidemiological profile as well as EGFR testing was retrieved.
Result:
345 patients were accrued. Targetable genetic alterations in EGFR were assessed in 74% (255/345) along the years and has a incremental pattern rising from only 22% of patients tested in 2011, 60% in 2012, 72% in 2013, 85% in 2014, to 100% of patients tested in 2015 and 2016. EGFR mutations were found in 18,03% (46/255) using the PCR COBAS method in tumoral tissue. EGFR mutations were more prevalent in women (30.09% vs. 9.60%; p < 0.001); and in never-smokers (49.12 vs. 9.58%; p < 0.001), but no significant difference was found regarding age under 50 year-old (27.66 vs. 17.28%; p = 0.159). The mean age of the mutated patients was 59 years (SD 11.82) with female predominance (74% vs. 26%). The most frequent genetic alteration detected was exon 19 deletion (50%), followed by L858R mutation (36%). Among the 46 patients with targetable EGFR mutation, 32 received getitinib or erlotinib in first or second line.
Conclusion:
Our findings shows that nowadays we have a good rate of screening of EGFR in advanced NSCLC. This improved over the years, reflecting the test availability, medical education with subespecialization, and easier acess to TKIs in CEPON. The prevalence of EGFR mutations in our population (18,03%) is slightly lower than the prevalence founded in other studies with brazilian patients (around 20%), maybe reflecting the european immigration in south of Brazil. Epidemiological profile is similar to previous studies showing EGFR mutation rates higher in female and non smokers patients.
