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Alessandro Brunelli
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P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)
- 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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P1.16-44 - Minute Ventilation-To-Carbon Dioxide Slope is Associated with Early and Long Term Survivals Following Anatomical Pulmonary Resection (ID 12415)
16:45 - 18:00 | Author(s): Alessandro Brunelli
- Abstract
Background
The aim of study was to identify that ventilation-to-carbon dioxide output (VE/V CO2) slope obtained from cardiopulmonary exercise test (CPET) was an independent prognostic factor of short and long term survival after lobectomy or segmentectomy.The aim of study was to identify that ventilation-to-carbon dioxide output (VE/V CO2) slope obtained from cardiopulmonary exercise test (CPET) was an independent prognostic factor of short and long term survival after lobectomy or segmentectomy.
a9ded1e5ce5d75814730bb4caaf49419 Method
974 patients including lobectomy (n=887) or segmentectomy (n=87) were performed from April 2014 to March 2018. 209 (22%) underwent CPET, and pulmonary function and several clinical factors including age, sex, performance status and comorbidities were retrospectively investigated to identify the prognostic factors with a multivariable Cox regression analysis.
4c3880bb027f159e801041b1021e88e8 Result
Among patients with CPET, 95 patients (46%) had VO2max<15 mL/kg/min. Compared to patients with higher VO2max, they had similar cardiopulmonary complication rates (32% vs. 29%, p=0.68) and 90 day mortality (9.5% vs. 6.2%, p=0.43). 172 patients had measured VE/V CO2. The incidence of cardiopulmonary complications in patients with VE/V CO2 slope >40 was 37% (19 of 51) vs. 27% (33 of 121) in those with lower slope values (p=0.19). However, 90-day mortality in patients with high VE/V CO2 slope (n=8) was 3-fold higher (16% vs. 5.0%) compared to those with lower (n=6) values (p=0.03). Cox regression analysis showed that higher VE/V CO2 values were significantly associated with poorer 2-year survival (HR 1.07, 95% CI 1.01-1.13, p=0.009)
8eea62084ca7e541d918e823422bd82e Conclusion
We found VE/V CO2 slope was associated with increased 90-day mortality and poorer 2-year survival in patients submitted to anatomical pulmonary resection for non-small cell lung cancer. These findings may assist the multidisciplinary team in selecting the most appropriate radical treatment in high-risk patients.
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P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)
- 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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P2.15-21 - Post Resection Lung Cancer Surveillance: Comparisons of Practice Between STS, ESTS and JACS Members (ID 12202)
16:45 - 18:00 | Author(s): Alessandro Brunelli
- Abstract
Background
We recently investigated contemporary practice in post-resection lung cancer surveillance, between the Society of Thoracic Surgeons (STS) and the European Society of Thoracic Surgeons (ESTS) updating a published STS survey and showed a wide variance of practice.
In order to understand better the role of socio-demographics on this divergence, we aim to compare these patterns to those of members of the Japanese Association for Chest Surgery(JACS) as well as surveillance attitudes across these regions.
a9ded1e5ce5d75814730bb4caaf49419 Method
A survey identical to the one conducted in 1995 among STS members was administered via mail or electronically to members of the STS, ESTS and JACS requesting responses from those treating NSCLC. Goodness of fit tests were used to compare profiles of respondents and attitudes toward testing between groups. Multivariable logistic regression was performed to examine for predictors of guideline concordant surveillance with CT.
4c3880bb027f159e801041b1021e88e8 Result
A total of 2978 STS member (response rate 7.8%, n=234), 1450 ESTS members (response rate 8.4%, n=122) and 272 JACS (response rate 40,8%, n=111) members were surveyed. All three societies reported similar use of history and physical examination for asymptomatic patients (75%vs78%vs73%p=0.52). Rate of guideline-recommended surveillance CT was reported highest among ESTS respondents for stage I patients (22% ESTS, 3% STS and 6% JACS members, p<0.01). However, both JACS and ESTS respondents reported higher rates of use of non-guidelines-recommended tests compared to STS respondents which persisted on adjusted analyses. In particular, JACS and ESTS respondents reported significantly higher use of brain MRI (JACS AOR 13.85 [7.46-25.73] ESTS AOR 2.81 [1.59-4.99], p<0.01), Bone Scan (ESTS AOR 3.00 [1.68-5.36] JACS AOR 5.69 [3.21-10.08], p<0.01) and bronchoscopy for post-resection surveillance (JACS AOR 3.51 [1.99-6.20] ESTS AOR 3.25 [1.83-5.79], p<0.01) compared to STS respondents. Regarding attitudes towards surveillance, more JACS and ESTS members either “agree” or “strongly agree” that routine testing for NSCLC recurrence results in potentially curative treatment (ESTS:86%, STS:70%, JACS:90% p<0.01). Similarly, JACS and ESTS respondents believe that surveillance would identify a curable second primary NSCLC (ESTS:94%, STS:84%, JACS:100% p<0.01) and that current literature documents definitive survival benefits from routine follow-up testing (ESTS:57%, STS:30%, JACS:62% p<0.01).
8eea62084ca7e541d918e823422bd82e Conclusion
The Japanese attitude towards surveillance is similar to that of ESTS members potentially highlighting significant differences between European and Asian surgeons compared to STS members and may be the underpinnings of routine use of non-guideline concordant surveillance. These differences clearly highlight the need of better prospective studies and joint recommendations to standardize practice globally.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)
- 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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P2.17-27 - IMpower030: Phase III Study Evaluating Neoadjuvant Treatment of Resectable Stage II-IIIB NSCLC with Atezolizumab + Chemotherapy (ID 12087)
16:45 - 18:00 | Author(s): Alessandro Brunelli
- Abstract
Background
A standard of care for resectable early-stage non-small cell lung cancer (NSCLC) is surgery alone or in combination with adjuvant or neoadjuvant platinum-based doublet chemotherapy (PT-DC). Nevertheless, 30%-70% of patients develop recurrence and die due to disease progression, highlighting the unmet need for more efficacious treatment regimens. Atezolizumab, an anti–programmed death-ligand 1 (anti–PD-L1) antibody that reinvigorates the anti-cancer immune response, has shown efficacy as monotherapy and in combination with chemotherapy in advanced NSCLC. On the basis of this activity, it is thought that the combination of atezolizumab and PT-DC may provide clinical benefit in the neoadjuvant setting by enhancing cancer cell killing and eradicating micro-metastases prior to surgery, thereby reducing the risk of disease recurrence. The objective of IMpower030 (NCT03456063) is to evaluate the efficacy and safety of atezolizumab in combination with PT-DC as neoadjuvant treatment for patients with resectable early-stage NSCLC.
a9ded1e5ce5d75814730bb4caaf49419 Method
IMpower030 is a global, Phase III, multicenter, double-blind, randomized study in patients with histologically or cytologically confirmed, resectable stage II, IIIA, or select IIIB (T3N2) NSCLC (per AJCC/UICC, 8th ed). Study inclusion requires measurable disease per RECIST v1.1, ECOG PS of 0/1, and eligibility for R0 resection with curative intent and PT-DC. Patients who have received prior therapy for lung cancer or who present with non-squamous NSCLC with activating EGFR mutations or ALK translocation are excluded. Approximately 302 patients will be randomized to receive 4 cycles of neoadjuvant atezolizumab (1200 mg Q3W, Arm A) or placebo (Arm B) in combination with an investigator-selected PT-DC regimen. Following surgical resection and pathology response assessment, treatment assignment will be unblinded; patients in Arm A will receive adjuvant treatment with atezolizumab for up to 16 cycles or until disease recurrence or unacceptable toxicity, whereas patients in Arm B will receive best supportive care and scheduled observational follow-up. The primary efficacy endpoint is major pathological response, defined as ≤ 10% residual viable tumor tissue at time of resection as assessed by an independent central pathology laboratory. Secondary efficacy endpoints include OS, ORR, investigator-assessed event-free survival and disease-free survival per RECIST v1.1, pathological complete response and patient-reported outcomes. Exploratory biomarkers will also be evaluated.
4c3880bb027f159e801041b1021e88e8 Result
Section not applicable
8eea62084ca7e541d918e823422bd82e Conclusion
Section not applicable
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)
- 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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P3.16-08 - Baseline Quality of Life is Influenced by the Duration of Abstinence from Smoking in Candidates to Lung Cancer Surgery (ID 12350)
12:00 - 13:30 | Author(s): Alessandro Brunelli
- Abstract
Background
The optimal interval of smoking cessation before Non-Small Cell Lung Cancer (NSCLC) surgery is still unknown. The objective of this study is to evaluate the influence of smoking cessation on the preoperative quality of life (QoL) of surgical NSCLC patients.
a9ded1e5ce5d75814730bb4caaf49419 Method
266 consecutive ever smokers (133 females) with a pack year history >=20 undergoing lung resections for NSCLC and with complete preoperative QoL data were analysed. The EORTC QoL summary score was calculated (SumS) as the average of the individual functional and reversed symptom scales (excluding Global-Health and Financial-Impact scales). The following smoking-related variables were tested for a possible association with SumS: age when the patient quit smoking and months elapsed from smoking cessation (for current smokers a value of 0 was used). These variables were entered as independent predictors in a stepwise multivariable regression analysis along with several patient-related baseline factors.
4c3880bb027f159e801041b1021e88e8 Result
108 patients were current smokers, 158 were ex smokers (quit at least 1month before surgery). We found no difference of preoperative QoL SumS between current smokers and ex smokers (81.5 vs. 83.0, p=0.66). Amongst the 158 ex-smokers, 69 quit smoking before the age of 60. Their SumS was similar to the one of those who quit older (84.2 vs. 82.0, p=0.30). A linear regression showed a significant association between the duration of abstinence from smoke and their QoL SumS (coefficient 0.02, SE 0.009, p=0.03). When the analysis was adjusted for other confounders using a multivariable regression analysis, the duration of abstinence from smoking (p<0.0001-longer time better QoL)(Fig1) and the age at which the patient quit smoking (p=0.001-older age better QoL)remained independently associated with SumS along with performance score.
Figure 1: Lowess Curve plotting SumS against the months elapsed from the time quit smoking.
8eea62084ca7e541d918e823422bd82e Conclusion
Patients should be counselled to stop smoking prior surgery independently as the QoL has expected to increase.
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