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Monica Castro



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    MA10 - Considerations in Immunotherapy / Real World (ID 911)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Advanced NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 10:30 - 12:00, Room 105
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      MA10.09 - NECPAL 2: A Multicentre Descriptive Study of Primary and Continuous Attention in Palliative Care in Argentina: Lung Cancer Cohort (ID 12928)

      11:30 - 11:35  |  Author(s): Monica Castro

      • Abstract
      • Presentation
      • Slides

      Background

      In Argentina Lung cancer is the most deadly neoplasm (9230 annuals death). Early identification of palliative care (PC) needs has proven benefits in terms of quality of life, survival, and decision making in Lung cancer patients. The NECPAL CCOMS-ICO© tool is face and content-validated instrument to identify patients likely in need of PC.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      To implement and evaluate a demonstration multicenter program for early and continuous PC for Lung cancer patients in Buenos Aires using the NECPAL-CCOMS-ICO© tool (multifactorial assessment) in every level of attention. We reported the results of one University Cancer center lung cancer cohort (2016-2018).

      We categorized patients as surprise question positive (SQ+), (Would you be surprised if this patient were to die in the next 12 month?). If the healthcare professional answered ‘NO’, the patient was considered SQ+ and they were also considered NECPAL+ when they presented at least one additional parameter from the NECPAL tool. All patients classified as NECPAL+ were considered to be in need of PC. Then using a Cox regression model analyzed predictors for overall survival (OS).

      4c3880bb027f159e801041b1021e88e8 Result

      82 patients out of 206 were SQ+ and NECPAL +. Median age 64 (35-82). 46 % had stage IVB (8th ) ,18 % IVA , 19.5% locally advanced, and 7 ptes early stage. 6 ptes presented SCLC . Male were 59%. 78 ptes were analyzed for overall survival; n=4 were excluded due lost of follow up. 56% had died with a Median OS of 11 months (7.2-14.7). 5/82 ptes did not receive any kind of oncology treatment due ECOG, comorbidities or patients’ choice. Median OS was 17 months (10.5-23.4) for men and 10 months (3.7-16.2) for females (p=0.08).

      In the univariate analyses, only metastasis in vital organs (nervous central system, liver, massive lung) was predicted of survival (17 vs 8 months; p=0.035). The other NECPAL indicators did not met the criteria for significance.

      The multivariate analysis, did not find a statistically significant combination of predictors for overall survival except metastasis in vital organs. It was noted an small number of low PPS score (11/78), as well as nutritional (14/78) or severe functional deterioration (5/78), in spite of the majority of the cohort had advanced disease.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This Program adds a prospective direct method of measuring prevalence of PC needs including a Palliative approach. The results presented support consideration of the NECPAL tool as a prognostic tool in our setting.

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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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      P1.15-08 - Implementation and Feasibility of the Assessment of EGFR Mutation in NSCLC Using Liquid Biopsy at an Argentinean University Hospital (ID 12943)

      16:45 - 18:00  |  Author(s): Monica Castro

      • Abstract
      • Slides

      Background

      Molecular characterization of lung cancer is standard of care. Almost 85% of NSCLC patients have advanced disease at diagnosis, being a challenge get enough tissue for diagnosis. That´ s why using less invasive methods as liquid biopsy by determining cftDNA (circulating free tumor DNA) represents a promising tool. The detection of EGFR mutations in plasma by Therascreen (EGFR RGQ Mutation Kit) showed a sensitivity and specificity of 65.4% and 100 % respectively. It is also useful to detect TKI´s resistance previous to clinical progression. The advantages of using PCR, even there are more sensitive methods available, are its simplicity and cost.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We will prospectively recruit EGFR mutation-positive (n=40) NSCLC patients. Plasma samples are collected: baseline, after three months of treatment, every six months and at the time of progression. We report our first interim analysis. We evaluate the concordance of EGFRm in tissue and plasma with the implementation of the Therascreen test (Qiagen). We test other available plasma EGFRm detection kit (EGFR Plasma Mutation Analysis Kit, Entrogen) (n=10)

      4c3880bb027f159e801041b1021e88e8 Result

      Since February 2017, plasma EGFRm status could be determined in 17 out of 22 NSCLC patients with EGFRm in tissue. L858R was present in 9 (53%), del19 in 7 (42%), del19+T790M in 1 (5%). Baseline plasma analyzed with Therascreen and Entrogen kits showed similar sensitivity of 61.1% and 66% respectively. Only 1/11 pt had discordance between both kits (Therascreen negative , entrogen DEL19+T790M ).

      In 17 analyzed ptes, median age was 59 (51-76) years. Most of the population were women (88%), were never smokers (58%), had stage IV disease (58%). Frequent site of metastasis was bone (n=7). With a median follow up of 18 months (12-23), 7/15 (56%) patients who experienced clinical progression were detected also in plasma. Two patients presented T790M in plasma without evidence of disease progression until last follow-up (July 2018). We also observed two patients with mutations detected out of range to be considered as positive which became positive for these mutations during the follow up.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This is the first work showing a cohort of EGFRm patients prospectively analyzed by successive liquid biopsies in a public institution in Argentina. We could successfully obtain cftDNA and analyze it by two commercial kits. The sensitivity of both kits was comparable to previous reports. The study is ongoing and more samples will be analized to shed light about the plasma dynamics of EGFRm related to clinical behavior.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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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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      P2.15-02 - Gender-Associated Differences in Patients with Lung Cancer Treated at an Argentinean University Hospital in the Last 10 Years  (ID 12207)

      16:45 - 18:00  |  Author(s): Monica Castro

      • Abstract
      • Slides

      Background

      In the last 20 years, lung cancer became in the first cause of death worldwide among women and is responsible for 20,000 deaths yearly in Argentinean women. Retrospective data suggest differences in incidence and outcome according to gender. We report the clinicopathologic profile and outcome of lung cancer patients assisted in our institution in the last decade according to gender.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively, relieved the female population with lung cancer with available data treated at Institute of oncology Angel H. Roffo in the last 10 years to compare their clinical, pathological and epidemiologic variables such as: age, gender, histology ,molecular testing (EGFR mutations, ALK rearrangement), PET-TC at diagnosis ,stage, ECOG, PS and weight loss, with a cohort of male patients in the same period of time and their outcome (OS)..

      4c3880bb027f159e801041b1021e88e8 Result

      From a total of 395 charts reviewed, 180 (45.6%) women and 215 (54.4%) men shared no differences in the median age of lung cancer diagnosis; 62 (30-92) and 63 (28-84) year, respectively (p=0,16). Differing from men, more women come from Buenos Aires urban and suburban areas (89 vs 79%) (p=0,003). Compared to men, women had a lower incidence of: SCC (squamous cell carcinoma) (24/180, 13% vs 38/215, 18%)(p=0,020), advanced disease (stage III-IV)(136/180, 75% vs 190/215 88%)(p=0,001), smoking history (126/180, 70% vs 203/215, 94%)(p=0,000), consumption of tobacco (Mean 24 pack/year ±30 vs 41±33) (p=0,000)and presence of symptoms at diagnosis (141/180, 78% vs 193/215, 90%)(p=0,006). At the molecular level, women had more positive EGFRm cases (28, 15% vs 13 6%) (p=0,008) than men. Overall, median survival was superior for women (24 months; IC95%, 20-28 vs 20 months; IC95% 15-24) (p=0,15), especially in stage IV disease, but it was not statistically significant.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our data confirms gender-associated differences in the clinical and pathologic profile of lung cancer in an Argentinean cohort of patients. Although not statistically significant, women would also had a better outcome than men. This analysis represents the first step of a prospective project to determine the clinic, epidemiological and molecular characteristics related to gender in lung cancer in our population

      6f8b794f3246b0c1e1780bb4d4d5dc53

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