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Edgardo Jiménez-Fuentes
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MA25 - Oligometastasis: Defining, Treating, and Evaluating (ID 929)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Oligometastatic NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 13:30 - 15:00, Room 203 BD
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MA25.10 - Complete Response by PET-CT After Radical Treatment in Oligometastatic Non-Small Cell Lung Cancer Predicts Longer Survival (ID 14232)
14:35 - 14:40 | Author(s): Edgardo Jiménez-Fuentes
- Abstract
- Presentation
Background
Evidence is rapidly accumulating for the use of radical treatment approaches for patients with oligometastatic Non-small cell lung cancer (NSCLC). Several limitations remain, however, to further strengthen the use of radical therapy as opposed to standard maintenance therapy, including a lack of robust markers to predict patient response. In this study, we assessed the utility of reaching a complete response (CR) by PET-CT in patients with oligometastatic disease after radical treatment (NCT02805530).
a9ded1e5ce5d75814730bb4caaf49419 Method
We included patients with stage IV NSCLC who presented with ≤5 synchronous, any-site metastases (oligometastatic disease) as assessed by PET-CT. Patients received 4 initial cycles of systemic treatment. Following, patients were evaluated by PET-CT and those with stable disease and partial response received radical treatment to the primary site and metastases (surgery, radiotherapy, chemotherapy plus radiotherapy, radiofrequency and SBRT alone or in any combination). Response to radical treatment was evaluated by PET-CT. Maintenance treatment was permitted.
4c3880bb027f159e801041b1021e88e8 Result
37 patients were included in the analysis. Mean age was 55.7. At diagnosis 43.2% of patients presented with CNS metastases. After 4 cycles of first-line therapy, 100% of patients received treatment to the primary site, while 83.8% also received therapy to metastases. Following radical treatment, 19 (51.4%) patients achieved a CR by PET-CT, while 18 (48.6%) had a partial response (NON-CR). Median PFS was 26.2 months (95%CI 12.2-40.1), and was positively affected by CR by PET-CT (NR vs. 14.3 [95%CI 11.9-16.7]; p<0.001). Median overall survival (OS) was NR. OS was also positively affected by CR by PET-CT (42-month survival: 82.5%±18 for CR vs. 34.4%±28 for NON-CR by PET-CT; p=0.01).
8eea62084ca7e541d918e823422bd82e Conclusion
Patients with oligometastatic NSCLC who undergo radical treatment and reach a CR by PET-CT show a significant improvement in survival outcomes. Our results suggest that CR by PET-CT could serve as a surrogate marker for prolonged survival in this patient su
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P1.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 947)
- 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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P1.15-20 - Diagnosis and Treatment Delay Among Patients with Lung Cancer in Mexican Population (ID 14070)
16:45 - 18:00 | Author(s): Edgardo Jiménez-Fuentes
- Abstract
Background
In Mexico, lung cancer is the seventh in incidence and first in mortality. Diagnosis in advanced stages accounts >70% of cases. We analyze factors associated with a late diagnosis and delay in the beginning of treatment.
a9ded1e5ce5d75814730bb4caaf49419 Method
Observational, cross-sectional study carried-out from August to October 2017 in the National Cancer Institute of Mexico (INCan). An interview was conducted to identify: 1) onset of symptoms, 2) time elapsed to seek medical attention, 3) number of doctors visited, 4) diagnosis established prior to cancer diagnosis pulmonary, 5) time elapsed from diagnosis of cancer until admission to INCan and 6) Time elapsed from diagnosis to start treatment.
4c3880bb027f159e801041b1021e88e8 Result
414 patients included and main characteristics are included in the next table
Mean age 64 years (±12.98) Genre 58% females Histology Adenocarcinoma - 74.6%
Epidermoid - 9.7%
Other – 15.7%Clinical Stage I - 5.5%
II - 3.7%
III - 16.2%
IV - 74.6%Physicians/Clinical Assessments Before Diagnosis 1 physician – 25%
2 physicians – 22.9%
≥3 physicians – 33.1%Risk factor Smoker – 44.7%
Wood smoke – 32%
Asbestos – 6%
Passive smoker – 6%Median time from beginning of symptoms to start of oncologic treatment are shown in the next image
8eea62084ca7e541d918e823422bd82e Conclusion
In Mexico, lung cancer is diagnosed in advanced stages due to a lack of clinical suspicion in primary care physicians. Delay from initial medical assessment to specialized center referral is considered an opportunity window. Identification of these factors will lead to establishment of public health policies that ensures improvement of diagnostic approach and the timely reference and initiation of treatment in specialized centers to improve the prognosis.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.11 - Screening and Early Detection (Not CME Accredited Session) (ID 977)
- 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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P3.11-14 - Low Rates of Lung Cancer Screening Among Doctors in Mexico (ID 14203)
12:00 - 13:30 | Author(s): Edgardo Jiménez-Fuentes
- Abstract
Background
Lung cancer represents the leading cause of death from cancer worldwide and in Mexico. Most patients are diagnosed in advanced stages at the time of diagnosis and treatment in these cases is palliative. Lung cancer screening with low-radiation exposure tomography has shown to reduce mortality due to early detection of the disease in high-risk individuals. In Mexico more than 80% of patients are diagnosed in the metastatic stage. Our objective is to know the frequency of screening for lung cancer among neumologists, thoracic surgeons and oncologists in Mexico and the reasons why they do not.
a9ded1e5ce5d75814730bb4caaf49419 Method
Transversal, descriptive study, carried-out during the international congress of pneumology and thoracic surgery from April 2-6, 2018, in Guanajuato, Mexico. A survey was conducted in Mexican doctors from different specialties and different public and private institutions, they were questioned if they consider screening for lung cancer useful, if they do it, if the screening can be applied to Mexico and what are the barriers that it finds not to do it. The data were emptied into a database in the SPSS v23 system and descriptive statistics were made for the analysis.
4c3880bb027f159e801041b1021e88e8 Result
A total of 147 specialist doctors were interviewed, 49% were oncologists, 43% were neumologists and 8% were chest surgeons. Despite the fact that 86% considered screening to be useful, only 36% performed it within their daily clinical practice. The main barriers they found to implement screening in our country were due to multiple factors according with response of 70% of physicians where lack of CT scan and qualified personnel to interpret image results were the most prevalent. The remaining 30% considered only one factor as the most important where the lack of infrastructure (CT scan) was the most prevalent in 14% of the answers.
8eea62084ca7e541d918e823422bd82e Conclusion
Although the specialists in prevention, diagnosis and treatment of lung cancer in Mexico are aware of the usefulness of screening for lung cancer, the frequency of implementation is low, mainly due to lack of appropriate infrastructure and trained personnel. It is necessary to implement public health policies to promote screening in the majority of patients who meet the high-risk criteria to increase early diagnosis and subsequently improve survival outcomes in this population.
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