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Meinoshin Okumura



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    MA23 - Early Stage Lung Cancer: Present and Future (ID 926)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 10:30 - 12:00, Room 105
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      MA23.11 - Lobe-Specific Nodal Dissection for Clinical Stage I and II Non-Small Cell Lung Cancer: Japanese Multi-Institutional Retrospective Study (ID 13741)

      11:40 - 11:45  |  Author(s): Meinoshin Okumura

      • Abstract
      • Presentation
      • Slides

      Background

      Systematic nodal dissection (SND) is an international standard of lymph node dissection for non-small cell lung cancer (NSCLC). Recently, lobe-specific patterns of mediastinal lymph node metastases have been recognized, and lobe-specific nodal dissection (LSD) has been proposed for early-stage NSCLC. The purpose of this study was to assess the surgical outcomes according to the extent of mediastinal lymph node dissection for patients with NSCLC by using a nationwide registry database.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From among 11,663 patients in a Japanese lung cancer registry study for 2004, 5392 patients with clinical stage (c-stage) I or II NSCLC that was completely resected by lobectomy and either SND or LSD were enrolled. Patients who received preoperative therapy or had middle lobe tumor were excluded. In the LSD group, inferior mediastinal (subcarinal) nodes were not dissected for upper lobe tumors, and superior mediastinal nodes were not dissected for lower lobe tumors. To reduce the selection bias, an inverse probability of treatment weighting (IPTW) method using a propensity score was implemented.

      4c3880bb027f159e801041b1021e88e8 Result

      LSD and SND were performed in 1,268 (23.5%) and 4,124 (76.5%) patients, respectively. LSD group included more c-IA and upper lobe tumors relative to SND group, although there was no significant differences in age and preoperative comorbidity. There was no significant difference in postoperative morbidity and mortality between 2 groups. Extended pathological N2 disease outside LSD area was found in 3.2% of the SND group, but recurrences were not different between 2 groups (all recurrences: 22.0% in LSD, 26.9% in SND; local recurrence: 6.1% in LSD, 7.7% in SND; p=0.788). The 5-year overall survival (OS) was 81.5% in LSD and SND in 75.9%. An IPTW–adjusted Cox model showed that LSD did not have a negative prognostic impact and instead was associated with favorable survival (hazard ratio: 0.68, 95% confidence interval: 0.60-0.77).

      8eea62084ca7e541d918e823422bd82e Conclusion

      This retrospective registry study suggested that LSD is an alternative to SND for selected patients with c-stage I or II NSCLC. Future prospective studies are warranted to determine whether LSD is applicable and provides clinical benefit for the general population of patients with cstage I or II NSCLC.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P1.14 - Thymoma/Other Thoracic Malignancies (Not CME Accredited Session) (ID 946)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.14-19 - Hemagglutinating Virus of Japan Envelope (HVJ-E: Inactivated Viral Nanoparticles) Against Chemotherapy-Resistant Pleural Mesothelioma (ID 12248)

      16:45 - 18:00  |  Author(s): Meinoshin Okumura

      • Abstract
      • Slides

      Background

      Hemagglutinating virus of Japan envelope (HVJ-E) derived from inactivated replication-defective Sendai virus possess the various antitumor activities. HVJ-E enhances multiple antitumor immunities such as activation of dendritic cells, induction of natural killer cells and CTL, and suppression of regulatory T cells, and it induces direct tumor-killing by the induction of cell death through the RIG-I/MAVS pathway by direct administration into the tumor.

      We performed the phase I dose escalation safety/tolerability and preliminary efficacy study of intra-tumoral and subcutaneous administration of HVJ-E in patients suffering from chemotherapy-resistant malignant pleural mesothelioma.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We performed the dose upward titration clinical study for checking the safety, drug tolerance, and preliminary efficacy of the intra-tumoral and subsequent subcutaneous administration of HVJ-E. We administrated HVJ-E to the patients 4 times per 2 weeks (the first was intra-tumoral, and residual 3 times were subcutaneous injection), and then washed out the drug from the body for 2 weeks. This cycle was repeated 2 times. We observed the patients for 8 weeks, and evaluated them by CTCAE, modified RECIST, and PERCIST.

      4c3880bb027f159e801041b1021e88e8 Result

      Three patients were enrolled as a low-dose group, and three patients were enrolled as a high-dose group. There was no discontinuation of the administration due to the severe adverse events.

      Results;

      The mean disease duration from confirmed diagnosis to this trial was 2.27 years (0.6-4.5 years). We defined the primary endpoint as an assessment of dose limiting toxicity related with HVJ-E. Neither serious adverse events (SAE) nor DLT were observed during the observation period. The following symptoms were observed. Fever (83.3%), and the local symptoms at injection site, for example, rubor, swelling, or induration (100%) were observed, but the local relapse of mesothelioma at the injection site was not observed. It was confirmed that the intra-tumoral and subcutaneous administration of HVJ-E was safe for chemotherapy-resistant pleural mesothelioma patients, because these AEs were transient and slight.

      The efficacy as a secondary endpoint was evaluated with modified RECIST, and PERCIST. DCR of low dose level cohort was 0% (0/3), because of PD, meanwhile, high dose level cohort indicated 100% (3/3). Consequently, the DCR of all cases who had treated with HVJ-E was 50% (3/6) by mRECIST, meanwhile, the DCR evaluated by PERCIST was 100%.

      8eea62084ca7e541d918e823422bd82e Conclusion

      It was suggested that HVJ-E was useful for disease control of advanced pleural mesothelioma patients without severe adverse events. Now we do the next step trial for malignant pleural mesothelioma and melanoma with high dose of HVJ-E.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 981)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.15-22 - Validation of Eurolung Risk Models in a Japanese Population: A Retrospective Single-Center Analysis of 612 Cases (ID 13280)

      12:00 - 13:30  |  Author(s): Meinoshin Okumura

      • Abstract
      • Slides

      Background

      The analysis of risk-adjusted outcome is beneficial for quality assessment in surgery as well as preoperative risk stratification. Eurolung risk models are recently reported, large population-based prediction tools of cardiopulmonary morbidity and mortality in patients who underwent anatomic lung resection. This study is aimed to evaluate validity of the models in a Japanese population.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From 2007 to 2014, 637 anatomic lung resections were performed in our institution. Patients who had induction therapy (n=23) and with missing data (n=2) were excluded from the analysis, and requisite variables (age, sex, body mass index, predicted postoperative forced expiratory volume in 1 s, coronary artery disease, cerebrovascular disease, chronic kidney disease, thoracotomy approach, extended resections, operation of pneumonectomy) were examined. Cardiopulmonary morbidity and 30-day mortality rates were estimated by Eurolung risk models according to the formula for computation (Brunelli A, et al. European risk models for morbidity (EuroLung1) and mortality (EuroLung2) to predict outcome following anatomic lung resections: an analysis from the European Society of Thoracic Surgeons database. Eur J Cardiothorac Surg, 2017; 51: 490-497). Aggregated Eurolung risk scores were also calculated, and patients with similar risk were classified into plural groups. These results were compared with observed outcomes. In addition, we analyzed long term outcomes of the groups using the Kaplan-Meier method.

      4c3880bb027f159e801041b1021e88e8 Result

      Surgical procedures included 9 pneumonectomies, 15 bilobectomies, 483 lobectomies, and 105 segmentectomies. Cardiopulmonary complications of any grade were occurred in 137 cases; this rate was lower than predicted by Eurolung1 (22.4% vs. 28.4%). Within 30 days after operation, 4 fatal cases were experienced, which was significantly lower than expected by Eurolung2 (0.7% vs. 6.9%). Morbidity rate was clearly stratified by Eurolung1 aggregate score as 0% (n=0, score 0-1), 14.7% (n=11, score 2-4), 18.6% (n=30, score 5-7), 21.3% (n=46, score 8-11), 34.5% (n=49, score 12-16), and 33.3% (n=1, score 17-19). Stratification of mortality rate by Eurolung2 aggregate score also developed apparent trend, although the observed number of death was quite small: 0% (score 0-3), 0% (score 4-6), 1.2% (score 7-8), 1.5% (score 9-11), 4.8% (score 12-14), and 0% (score 15-17). The Higher (8-19) Eurolung1 aggregate score group showed poor 5-year overall survival compared with the lower (0-7) score group (72.3% vs. 90.4%, P<0.01).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Eurolung risk models did not completely match with the morbidity and mortality in our institution. On the other hand, Eurolung1 aggregate score was useful to predict not only morbidity, but also long term outcomes.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    PC03 - Controversies in Management of Resectable Thymoma (ID 842)

    • Event: WCLC 2018
    • Type: Pro-Con Session
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 15:15 - 16:45, Room 205 AC
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      PC03.05 - Debate on Standard Surgical Approaches - Open Thymectomy (ID 11611)

      15:55 - 16:05  |  Presenting Author(s): Meinoshin Okumura

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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