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Luis Alberto Mas Lopez
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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: 2
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.15-07 - Lung Cancer in the Young (ID 14248)
16:45 - 18:00 | Author(s): Luis Alberto Mas Lopez
- Abstract
Background
Lung cancer is the leading cause of cancer related death worldwide. Median age at diagnosis is 70 years. Its presentation in patients 40 or younger is uncommon and it has been proposed that maybe is a different disease due to its clinical characteristics and genetic makeup. There are a limited number of studies in this population and they report different clinico-pathological characteristics in comparison with older patients.
a9ded1e5ce5d75814730bb4caaf49419 Method
This is a retrospective analysis of patients 40 years or younger diagnosed with lung cancer between 2009 and 2015 at Instituto Nacional de Enfermedades Neoplasicas (INEN) in Lima, Peru. Patient characteristics such as age, sex, smoking history, family history, symptoms, histological type, stage at diagnosis, and overall survival were collected from clinical files.
4c3880bb027f159e801041b1021e88e8 Result
During the study period, we identified 2946 patients with lung cancer. Among these, 107 (3.63%) patients were 40 years or younger. Median age at diagnosis was 36 years and 58% of patients were female. Most patients (77.5%) lacked family history of cancer. A smoking history was present in 13.3% of patients and exposition to biomass fumes from inhouse cooking was reported in 16.3%. Mean time from onset of symptoms to diagnosis was 2 months. Frequent symptoms at diagnosis were cough (59.2%), weight loss (56.1%), chest pain (50%), dyspnea (44.2%), hemoptysis (18.4%) and fever (9.6%). Most patients (59.8%) had performance status (PS) of 1. Adenocarcinoma was the most histological type (64.5%), followed by not otherwise specified (NOS) lung cancer (13.1%), squamous carcinoma (10.3%) and neuroendocrine carcinoma (5.6%). Almost all patients (96.9%) had unresectable disease at diagnosis (7.3%, stage III; 89.6% stage IV). The median overall survival was 7 months (range 4.4 – 9.5).
8eea62084ca7e541d918e823422bd82e Conclusion
The proportion of young patients with lung cancer in our population is higher than that reported in the literature. Lung cancer in the young is mostly sporadic, more frequent in women and usually of adenocarcinoma type. Young patients tend to present with advanced disease at diagnosis, resulting in a very poor survival. The molecular characterization of this cohort of patients is ongoing.
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P2.15-23 - Are there Ethnic Disparities in the Clinical Outcomes of Non-Small Cell Lung Cancer Hispanic Patients Treated with Immunotherapy? (ID 12359)
16:45 - 18:00 | Author(s): Luis Alberto Mas Lopez
- Abstract
Background
Immunotherapy outcomes in non-small cell lung cancer (NSCLC) are widely available thanks to studies that got the approval of PD-1/PD-L1 inhibitors. However a careful review of ethnicity can find that most of the studies were done in Non-Hispanic White or Asian populations. There is little known about the outcomes in Hispanics (H). It is well known that Hispanics (H) in the US seem to have a lower age-adjusted mortality in NSCLC and have a different gene expression profile than NHW with higher prevalence of EGFR mutations.
a9ded1e5ce5d75814730bb4caaf49419 Method
We reviewed clinical outcomes in 216 H pts with NSCLC stage IV treated with atezolizumab, nivolumab or pembrolizumab at 4 large cancer centers (Memorial Cancer Institute, University of Miami and Moffitt Cancer Center all of them in Florida (US), and the National Cancer Institute in Peru. These patients have failed at least one line of chemotherapy previously. All of these patients did not have actionable genes (EGFR. ALK, ROS-1). We assessed overall response rate ORR (CR+PR) as main objective and disease control rate (DCR: ORR+SD), median PFS (progression free survival) & overall survival (OS) and PFS at 6m and 12m as secondary objectives.
4c3880bb027f159e801041b1021e88e8 Result
Most of the pts were males: 116 (54%), 82% adenocarcinomas and the median age was 65 years (range: 37-88y). The ORR was 16% and the DCR that shows the clinical benefit was 67%. ORR and DCR were similar in adenocarcinomas (20%/68%) and squamous cell carcinomas (17%/64%). The progression free survival (PFS) at 6 months (m) and 12m were 80% and 56% respectively. Median PFS 14.5m and median overall survival were 19m, respectively.
8eea62084ca7e541d918e823422bd82e Conclusion
ORR for NSCLC pts treated with immunotherapy is 16% in Hispanics treated at 4 cancer centers compared to an expected 20% ORR for NHW as reported in the literature. Therefore it appears that Hispanics might not have a benefit from immunotherapy to the extent that NHWs do. We need a larger cohort and prospective studies to validate these findings.
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: 2
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.15-10 - Survival Impact of Peripheral Blood Ratios in Lung Cancer According Clinical Stage (ID 14061)
12:00 - 13:30 | Author(s): Luis Alberto Mas Lopez
- Abstract
Background
Lung cancer represents one of the most frequent and letal neoplasms in many regions, where most patients are still diagnosed as advanced disease, and many biomarkers have been studied unsuccessfully. Peripheral blood ratios as Neutrophil-to-lymphocyte ratio (NLR), Monocyte-to-lymphocyte ratio (MLR) and Platelets-to-lymphocyte ratio (PLR) have been studied as potential biomarkers of systemic inflammation but cut-off values are still difficult to stablish. We explored the survival impact of different cut-off values according clinical stages in lung cancer.
a9ded1e5ce5d75814730bb4caaf49419 Method
We analyzed medical records of 193 patients with lung cancer treated at ONCOSALUD–AUNA 2011-2014. Peripheral blood data was obtained retrospectively from the first medical visit and we calculated optimal cut-off values using the maximally selected rank statistics according every clinical stage (CS). Overall survival (OS) was evaluated using Kaplan-Meier method and survival curves comparison was performed using log-rank test or Breslow.
4c3880bb027f159e801041b1021e88e8 Result
Median age was 67 years (range: 34-88), 51% were women and 71.5% had 0-1 ECOG scale. The 9.8, 11.4, 18 and 60% were CS I, II, III and IV. The most common metastatic sites were brain, bones, cervical and supraclavicular nodes. Patients with I CS underwent to lobectomy, and 59% of II and most III-IV CS received chemotherapy. The median follow-up was 4.9years, median OS was 1.4years (95%CI: 1.1-1.9) and 2 and 5years OS were 42% and 25%, respectively. The next table shows survival impact of blood ratios according CS. Optimal cut-off values were different according every CS of lung cancer, however in the IV CS group the cut-off of 2.6 and 0.31 for NLR and MLR showed significant survival impact on OS.
8eea62084ca7e541d918e823422bd82e Conclusion
Our results suggest that exists different cut-off values for blood ratios according every clinical stage that needs to be explored among larger population data-bases to confirm it. In advanced disease, NLR and MLR show significant survival impact in this study.
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P3.15-11 - Association Between Peripheral Blood Ratios and Clinical Stage Disease in Lung Cancer. (ID 14312)
12:00 - 13:30 | Author(s): Luis Alberto Mas Lopez
- Abstract
Background
Many attempts have been described to stablish peripheral blood ratios as systemic immune biomarkers in lung cancer, unfortunately they are not still considered because of lack accuracy and sensibility. In this study, we explore and correlate clinical stages to median values of peripheral blood ratios as Neutrophil-to-lymphocyte ratio (NLR), Monocyte-to-lymphocyte ratio (MLR) and Platelets-to-lymphocyte ratio (PLR) among patients with lung cancer.
a9ded1e5ce5d75814730bb4caaf49419 Method
Retrospectively, we review clinical and laboratory data from 193 patients with lung cancer treated at Oncosalud – AUNA from 2011 to 2014. The laboratory data (hemoglobin, leukocytes, neutrophil, lymphocyte and monocyte) were collected from blood routine test obtained from the first clinic visit. The median (range) and mean (± SD) of the ratios were determined according every clinical stage and compared using the U Mann Whitney test.
4c3880bb027f159e801041b1021e88e8 Result
Median age was 67 years, and 63 (34-79), 64 (37-83), 69 (44-88) and 67 (38-86) years in I, II, III and IV CS, respectively. In early disease (I-II), female patients were slightly more frequent that men. Median hemoglobin was 13.6, 12.4, 13 and 12.7 gr/dl for I, II, III and IV CS, respectively. Peripheral blood levels (leukocytes, lymphocytes, monocytes and platelets) show a slightly higher level among patients with advanced disease. Median NLR, MLR and PLR are described in the following table, there was a significant difference between early and advanced disease (III and IV CS) for NLR and MLR.
8eea62084ca7e541d918e823422bd82e Conclusion
These results suggest that there are higher levels of peripheral blood ratios related to advanced disease; but larger studies are needed to confirm it. Only NLR and MLR showed differences between early and advanced disease.
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