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Vladmir CC de Lima



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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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      P1.15-07 - Geriatric Oncology - Lung Cancer in Elderly Patients and Palliative Treatment: Prospective Analysis of A. C. Camargo Cancer Center (ID 13550)

      16:45 - 18:00  |  Author(s): Vladmir CC de Lima

      • Abstract
      • Slides

      Background

      Special attention is required by elderly population, due to chemotherapy (ch) risks and comorbidities, which may limit the capacity to deliver optimal cancer care. We aimed to describe the clinical features and survival outcomes of elderly patients (pts) with lung adenocarcinoma (ADC) treated with non-curative intent at A. C. Camargo Cancer Center.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We evaluated all pts aged 70+ with lung ADC treated with ch or target therapy in 1st or 2nd-line from 2007 to 2015 who underwent a comprehensive geriatric assessment (CGA), in a convenient prospective series. We used summary statistics to describe the population. Overall survival (OS) was calculated according to Kaplan-Meier method, from CGA date to last follow-up or death. We performed univariate and multivariate analysis in order to look for potential prognostic factors for OS.

      4c3880bb027f159e801041b1021e88e8 Result

      CGA was done in 55 pts aged ≥70y with lung ADC. The median age was 76y and 22% had ECOG ≥ 2. Half of pts were male. 51% had polypharmacy (≥5 drugs). Pts were functionally classified according to activities of daily living (ADL): 76% as Katz A and 50% as Lawton ≤27. 68.5% were at risk for malnutrition or malnourished. The median age-adjusted Charlson Comorbidity score was 10 – remembering that 4+ is considered clinically significant. 61% had ≥2 comorbidities and 26 pts had at least 2 metastatic sites. CNS was affected in 7.5% of the cases and liver in 9.2%. 79.6% of the pts underwent ch and the others received target therapy. After follow-up of 29m, median OS was 17.1 months (13.5-27.8m). In univariate analysis, significantly worse survival outcomes were observed for pts with ECOG 2-4 (HR 10.6; p < 0.001), increasing number of sites of metastases (HR 2.2; p = 0.04) and hepatic metastasis (HR 6.03; p < 0.001). In the multivariate analysis, male gender, ECOG 2-4 and liver metastasis were associated with higher risk of death.

      8eea62084ca7e541d918e823422bd82e Conclusion

      ADL, an important part of CGA, showed little prognostic value in our small population. Pts with ECOG 2-4 or hepatic metastasis were those that presented the highest risk of death. CGA is a good tool to help in stratifying risk of elderly cancer pts and is mandatory in cost-benefit analysis to identify the best treatment to each individual patient.

      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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      P2.01-31 - Updated EGFR Mutation Frequency in 1,689 NSCLC Brazilian Patients – A National-Wide Study (ID 14267)

      16:45 - 18:00  |  Author(s): Vladmir CC de Lima

      • Abstract
      • Slides

      Background

      EGFR mutation status is crucial to improving therapeutic results in advanced NSCLC, due to the development of highly effective EGFR-TKIs. Recent local data suggest that EGFR mutation frequency is lower in Brazil ( 22%-33%) than in Asia and higher than in North America and Europe. We intended to describe the EGFR mutation frequency in a large national-wide Brazilian population.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This retrospective analysis evaluated a database composed of samples collected between January and August 2017, from all Brazilian regions. Tumor tissue samples of patients with advanced NSCLC were submitted, at discretion of attending physicians, for EGFR mutation testing. EGFR exons 18 to 21 were analyzed by cobas®, NGS, or other non-specified test. Unfortunately, smoking status data was not available and was not included in this analysis.

      4c3880bb027f159e801041b1021e88e8 Result

      1,689 tests were included. Table-1 demonstrates EGFR mutation rates according to test used. Mean age (±SD) was 64.5 (±11.3) for female and 66.0 (±11.1) for male population. From all detected mutations, exon 19 deletion was the most frequent (49.2%), followed by L858R (25.6%), exon 20 insertion (8.4%), T790M (4,7%), and G719X (3.0%). Patients with multiple EGFR variants (more than one EGFR mutation) corresponded to 10.3% of cases. Among different Brazilian geographic macro-regions, EGFRm rate was 33.3% in North (36 tests only), 25.1% in Northeast (307 tests), 30.9% in Central-West (175 tests), 25.8% in Southeast (841 tests), and 20.6% in the South (330 tests) region.

      Table1 – EGFR mutation rate divided by gender and EGFR mutation detection method.

      cobas®

      NGS

      Other

      Overall

      Female

      58/183

      (31.7%)

      223/586

      (38.1%)

      25/159

      (15.7%)

      306/928

      (33.0%)

      Male

      25/167

      (15.0%)

      89/447

      (19.9%)

      9/147

      (6.1%)

      123/761

      (16.2%)

      Overall

      83/350

      (23.7%)

      312/1,033

      (30.2%)

      34/306

      (11.1%)

      429/1689

      (25.4%)

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our findings confirm that EGFR mutation rate among Brazilian is higher than observed in Western countries, women have a higher EGFR mutation rate than men, and detection rate using NGS is higher than cobas®. Frequency of EGFR mutation was lower in South region, what could be explained by a higher smoking rate (not evaluated in this study) and a larger Caucasian population.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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