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LINU ABRAHAM Jacob



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    Lunch & Poster Display session (ID 58)

    • Event: ELCC 2019
    • Type: Poster Display session
    • Track:
    • Presentations: 2
    • Moderators:
    • Coordinates: 4/11/2019, 12:30 - 13:00, Hall 1
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      207P - Primary mucinous carcinomas of the lung: Clinical characteristics and treatment outcomes (ID 340)

      12:30 - 13:00  |  Author(s): LINU ABRAHAM Jacob

      • Abstract

      Background

      Invasive mucinous carcinoma (IMA) is a distinct histopathologic variant of adenocarcinomas of lung comprising about 2 – 10%. A large proportion of IMAs carry KRAS mutations and only rarely EGFR mutations or ALK/ROS translocations, thus most cases are not amenable for targeted therapy at present. This study was conducted to elicit the unique clinico-pathological characteristics of IMA.

      a9ded1e5ce5d75814730bb4caaf49419 Methods

      Medical records of patients diagnosed with IMA by needle biopsy at Kidwai Cancer Institute, Bangalore from 2013 to 2018 were retrieved, clinical presentations and treatment outcomes were reviewed. Statistical analysis was performed using SPSS version 23.0.

      20c51b5f4e9aeb5334c90ff072e6f928 Results

      490 cases of needle biopsy of lung were done at our institute between 2013 and 2018. Nine cases (1.8%) were diagnosed as IMA. The median age was 59 years (range 49 – 76 years). The male female ratio was 2:1. Six (66.7%) were current smokers with pack year greater than 20. The median symptom duration before diagnosis was 3 months. Three (33.3%) of the cases were initially misdiagnosed as pneumonia in view of CT findings of pneumonia-like multifocal consolidative appearance. Lung was the most common site of metastasis (77.8%). Serum CEA was elevated in six cases (66.7%). None of the cases had any mutations in EGFR gene or ALK and ROS1 translocations. All cases were treated with Pemetrexed-Carboplatin followed by Pemetrexed maintenance till progression. 5 (55.6%) patients had stable disease, 3 (33.3%) had partial response and 1 (11.1%) had progressive disease after three months of therapy. Median PFS was 12 months (Range 3 – 18 months). Docetaxel was given as second line chemotherapy in all progressed patients. Best response noted was stable disease; seen in 4 (57.1%) cases. Median PFS with docetaxel was 6 months (range 3- 8 months). Median overall survival 16 months (range 9 - 27 months). Patients with progressive disease had serial rise in Serum CEA.

      fd69c5cf902969e6fb71d043085ddee6 Conclusions

      IMA is rarely diagnosed on needle biopsies due to insufficient tissue for characterisation. They mimic pneumonia on imaging thus delaying diagnosis. EGFR mutations, ALK and ROS1 translocations are usually negative. Response to chemotherapy is modest. Serum CEA may be used as a tumor marker for response assessment.

      b651e8a99c4375feb982b7c2cad376e9 Legal entity responsible for the study

      Kidwai Cancer Institute.

      213f68309caaa4ccc14d5f99789640ad Funding

      Has not received any funding.

      682889d0a1d3b50267a69346a750433d Disclosure

      All authors have declared no conflicts of interest.

      cffcb1a185b2d7d5c44e9dc785b6bb25

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      210TiP - Evaluation of safety and efficacy of minocycline combined with tyrosine kinase inhibitors in patients of EGFR mutated metastatic lung cancer (ID 338)

      12:30 - 13:00  |  Author(s): LINU ABRAHAM Jacob

      • Abstract

      Background

      Tyrosine Kinase Inhibitors (TKI) are used in the first line management of metastatic Non-Small cell lung cancer in the presence of EGFR activating driver mutations. Skin rash is one of the most common side effects associated with the use of TKIs and Minocycline is recommended for prophylaxis and treatment of TKI induced skin rash. An exploratory analysis of a Phase III study evaluating the role of Minocycline with regard to skin rash showed a trend toward improved survival in such patients. This finding can be backed by appropriate biologic rationale as Minocycline has been shown to inhibit PARP-1 in in-vitro studies and EGFR mutated lung cancers are deficient in BRCA1 leading to a synthetic lethality in tumor cells exposed to both these drugs. This study is intended to assess the safety and efficacy of minocycline in patients of metastatic Non-Small Cell Lung cancer treated with a combination of TKIs and Minocycline.

      a9ded1e5ce5d75814730bb4caaf49419 Trial design

      Objectives Primary To assess and compare Response rates in patients receiving TKIs and minocycline versus those receiving TKI alone To assess the toxicity with addition of minocycline to TKIs Secondary To assess and compare PFS and OS in patients receiving TKIs and minocycline versus those receiving TKIs alone Materials and Methods Type of Study - A phase 2 randomized study Patients – Metastatic NSCLC with EGFR mutations sensitive to Gefitinib Arms – Gefitinib 250mg/day alone Gefitinib 250mg/day + Minocycline 100mg/day Study site and duration Kidwai Cancer Institute; July 2018 to June 2020 Inclusion Criteria Patients of Metastatic Biopsy Proven NSCLC with an EGFR sensitising mutation to Gefitinib Age 18 – 80 Exclusion Criteria Any other Synchronous / Metachronous cancer or any uncontrolled co-morbidities Sample size N = 50 in each arm Randomization – Simple Random Method, Lottery Method Statistical Analysis - The Mann-Whitney U test and the χ2 test will be used to determine statistically significant differences between the two groups, Kaplan-Meier method to assess survival curves, Log-rank test to evaluate the statistical significance of differences and Cox proportional hazards model for multivariate analysis of the effect of clinicopathological factors on survival.

      d9b324a48b043b3d87bc9b3fe620f260 Legal entity responsible for the study

      Kidwai Cancer Institute.

      213f68309caaa4ccc14d5f99789640ad Funding

      Has not received any funding.

      682889d0a1d3b50267a69346a750433d Disclosure

      All authors have declared no conflicts of interest.

      cffcb1a185b2d7d5c44e9dc785b6bb25