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Diana Flores
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MA02 - Improving Outcomes for Patients with Lung Cancer (ID 895)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 10:30 - 12:00, Room 201 BD
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MA02.08 - The Effect of Nabilone on Appetite, Nutritional Status, and Quality of Life in Lung Cancer Patients: A Randomized, Double-Blind Clinical Trial (ID 13428)
11:15 - 11:20 | Author(s): Diana Flores
- Abstract
- Presentation
Background
Over one half of the patients diagnosed with advanced lung cancer experience anorexia. In addition to its high incidence, cancer-induced anorexia promotes the development of the anorexia-cachexia syndrome, which is related to poor clinical outcomes. Recently, drugs derived from cannabinoids, such as Nabilone, have been recognized for their appetite improvement properties; however, clinical trials to support their use in cancer patients are necessary.
a9ded1e5ce5d75814730bb4caaf49419 Method
This is a randomized, double-blind, placebo-controlled clinical trial to assess the effect of Nabilone vs. placebo on the appetite, nutritional status, and quality of life in patients diagnosed with advanced Non-small cell lung cancer (NSCLC) (NCT02802540).
4c3880bb027f159e801041b1021e88e8 Result
A total of 65 patients from the outpatient clinic at the National Institute of Cancer (INCan) were assessed for eligibility and 47 were randomized to receive Nabilone (0.5 mg/2 weeks followed by 1.0 mg/6 weeks) or placebo. After 8 weeks of treatment, patients who received Nabilone increased their energy intake (342-kcal) and had a significantly improvements in Quality of life parameters.
8eea62084ca7e541d918e823422bd82e Conclusion
Nabilone is an adequate and safe therapeutic option to aid in the treatment of patients diagnosed with anorexia. Larger trials are necessary in order to draw robust conclusions in regard to its efficacy in lung cancer patients.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P1.01 - Advanced NSCLC (Not CME Accredited Session) (ID 933)
- 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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P1.01-03 - Effect of Prophylactic Cranial Irradiation on Cognitive Function and QoL in NSCLC Patients at High Risk of Brain Metastases (ID 14166)
16:45 - 18:00 | Author(s): Diana Flores
- Abstract
Background
Up to 50% of NSCLC patients develop brain metastases (BM). Prophylactic Cranial Irradiation (PCI) is a potentially useful strategy to prevent this event, although its use remains controversial due to inherent risks. Therefore, actions such as dose adjustment for Whole Brain Radiotherapy (WBRT), or hippocampal-sparing techniques have been explored. We evaluated the impact of PCI on cognitive function and Quality of Life (QoL).
a9ded1e5ce5d75814730bb4caaf49419 Method
Within the clinical trial NCT01603849 we evaluated a total of 84 histologically-confirmed NSCLC patients with high risk of developing BM (adenocarcinomas harboring oncodrivers (EGFR or ALK) and/or carcinoembryonic antigen (CAE) level at diagnosis ≥20 pg/mL). Patients were randomized 1:1, 41 to receive PCI and 43 to observation. Cognitive function (CF) was evaluated before and after treatment and at 6, 9 and 12 months with Mini Mental State Examination (MMSE). Reliable Change Index was used to evaluate the effect on CF. QoL was assessed through the European Organization for Research and Treatment of Cancer (EORTC-QLQ-30). Differences between groups were compared with Mann Whitney U and Friedman test. OS was estimated from the first MRI assessing the absence of BM until death/last follow-up with Kaplan-Meier and compared with Log-Rank test.
4c3880bb027f159e801041b1021e88e8 Result
83.3% of patients presented an EGFR-mutation (n=60) or ALK-rearrangement (n=6). Median OS was 42.8 vs. 25.9 months among patients with or without PCI (p=0.031). MMSE scores and median score values for global QoL, fatigue and cognitive functioning did not differ among groups or at baseline and follow-up. There were also no differences in percentual change at 1-yr (Table).
8eea62084ca7e541d918e823422bd82e ConclusionClinical changes (MMSE)
3 months
6 months
9 months
1 yr
n/N (%)
n/N (%)
n/N (%)
n/N (%)
Without PCI
Without Changes
38/43 (88.4)
34/42 (81)
34/42 (81.0)
29/37 (78.4)
Cognitive Deterioration
0/43 (0)
2/42 (4.8)
0/42 (0)
0/37(0)
Cognitive Improvement
5/43 (11.6)
6/42 (14.2)
8/42 (19.0)
8/37 (21.6)
With PCI
Without Changes
39/41 (95.1)
31/34 (91.2)
31/34 (91.2)
27/31(87.1)
Cognitive Deterioration
1/41 (2.4)
0/34 (0)
0/34 (0)
1/31(3.2)
Cognitive Improvement
1/41 (2.4)
3/34 (8.8)
3/34 (8.8)
3/31 (9.7)
Baseline
3 months
6 months
9 months
1 yr
p-Value (*)
Diff. at 1 yr
Median (IQR)
Median (IQR)
Median (IQR)
Median (IQR)
Median (IQR)
Median (IQR)
Global QoL
Without PCI
66.7 (50.0 - 83.3)
66.7 (50.0 - 83.3)
66.7 (64.6 - 83.3)
83.3 (66.7 - 85.4)
83.3 (75.0 - 87.5)
<0.001
8.3 (0.0 - 29-2)
With PCI
66.7 (50.0 - 83.3)
66.7 (50.0 - 83.3)
66.6 (66.7 - 83.3)
83.3 (66.7 - 83.3)
83.3 (75.0 - 83.3)
<0.001
0.0 (0 - 25.0)
p-Value (diff between groups)
0.956
0.786
0.903
0.172
0.595
0.791
Fatigue
Without PCI
22.2 (11.1 - 44.4)
33.3 (22.2 - 44.4)
22.2 (11.1 - 44.4)
22.2 (11.1 - 44.4)
22.2 (11.1 - 33.3)
<0.001
0.0 (-22.2 - 0.0)
With PCI
22.2 (5.6 -33.3)
33.3 (11.1 - 33.3)
22.2 (8.3 - 33.3)
22.2 (8.3 - 33.3)
22.2 (0.0 - 33.3)
<0.001
0 (0 - 0)
p-Value (diff between groups)
0.493
0.132
0.942
0.931
0.93
0.553
Cognitive
Without PCI
83.3 (66.7 - 100.0)
83.3 (66.7 - 100.0)
83.3 (66.7 - 100.0)
73.3 (83.3 - 100.0)
73.3 (83.3 - 100.0)
0.004
0 (0 - 0)
With PCI
83.3 (66.7 - 100.0)
83.3 (66.7 - 100.0)
83.3 (66.7 - 100.0)
91.7 (70.8 - 100.0)
83.3 (83.3 - 100.0)
0.017
0.0 (0.0 - 0.0)
p-Value (diff between groups)
0.854
0.983
0.521
0.411
0.757
0.734
PCI was not associated with significant differences in MMSE and QoL scores, furthermore there were no differences when assessing specific subscales (e.g. fatigue and cognitive functioning). These results along with the clinical benefit in OS highlight the benefit of this approach particularly among patients at high risk of developing BM.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.01-11 - Characteristics of Non-Small Cell Lung Cancer: Differences by Sex and Hormonal Status in a Hispanic Population (ID 12789)
16:45 - 18:00 | Author(s): Diana Flores
- Abstract
Background
Non-small Cell Lung Cancer (NSCLC) appears to be a different disease between women and men. Clinical features and lung cancer behavior by sex and particularly by hormonal status has been poorly approached. We describe the differences in NSCLC by sex and by hormonal status among women in a Hispanic population.
a9ded1e5ce5d75814730bb4caaf49419 Method
We performed a retrospective study among NSCLC patients from the National Cancer Institute of Mexico. We assessed clinic-pathological (tobacco, wood smoke and asbestos exposure, histology, disease stage, ECOG, Body Index Mass, Metastases sites) and molecular characteristics (EGFR and KRAS mutation profile). Overall survival (OS) according to sex and hormonal status were estimated using the Kaplan-Meier method and compared using the Log-rank test. Multivariate cox-proportional analysis was performed adjusting for clinical and statistically relevant features.
4c3880bb027f159e801041b1021e88e8 Result
Among the 1,104 patients 52.7% were men and 47.3% were women. Compared to men, women were more likely to be non-smokers (68% vs. 23%, p<0.001), reported higher frequencies of wood-smoke exposure (50% vs 28.2%, p<0.001), and of EGFR-sensitizing mutations (38.8% vs 18.7%, p<0.001), had a better ECOG performance (<2) (76.2% vs 69.9%, p=0.020) and showed a higher frequency of BMI ³25 (48.4% vs 41.5% p=0.003). Likewise, women, showed better OS (p=0.021) compared to men as well as overweight patients (vs. normal or obese patients) (p=0.045), non-smokers (p=0.002) and patients with lower ECOG status (p=0.006). Differences were found also when considering hormonal status. Postmenopausal women showed higher wood-smoke exposure (52.5% vs 41.7%, p=0.037) and wood-smoke exposure index (113.2% vs 50.6%, p=0.006) as well as tobacco smoking exposure index (19.8 vs 10.2, p=0.017) compared to premenopausal younger women who exhibited higher frequencies of exposure to asbestos (16.7% vs 7.0%, p=0.001) compared to postmenopausal. OS was better in postmenopausal women compared to premenopausal (31.1 vs 19.4 months, p=0.046). No differences were found between premenopausal and postmenopausal women stratified by EGFR mutation status regarding their clinic-pathological and molecular characteristics, neither in the OS.
8eea62084ca7e541d918e823422bd82e Conclusion
Our results support the differences in lung cancer presentation by sex and also by hormonal status. It is important to highlight that wood-smoke exposure and tobacco consumption were associated with hormonal status. Furthermore, premenopausal women (which showed a younger age at diagnosis) showed a worse OS regardless of other molecular features (e.g. EGFR, KRAS) which highlights the need of investigating in detail hormonal profiles when considering the clinical approach of NSCLC diagnosis and treatment.
6f8b794f3246b0c1e1780bb4d4d5dc53
