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EP1.06 - Mesothelioma (ID 196)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Mesothelioma
- Presentations: 1
- Now Available
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
EP1.06-08 - A Retrospective Analysis on Sarcomatoid Mesothelioma to Identify If Chemotherapy Provides Greater Overall Survival Compared to BSC (Now Available) (ID 1229)
08:00 - 18:00 | Presenting Author(s): Rachel Thomas
Sarcomatoid is the least common, but most aggressive type of mesothelioma (1) accounting for approximately 11% of all malignant pleural mesothelioma (MPM) (2). However, unlike lung cancer which has different treatment depending on histology, Mesothelioma has the same treatment, regardless of cell type (3, 4). Current data suggests patients with Sarcomatoid Mesothelioma have an average of 5.3 months survival from diagnosis. (5).Method
A retrospective analysis was undertaken on 9 Sarcomatoid Mesothelioma patients diagnosed and treated from March 2017 to November 2018.
The aim of the audit was to identify if patients who received chemotherapy had better overall survival when compared to those patients’ who received best supportive care (BSC).
All of the 9 patients were PS 0/1 at time of diagnosis.
5 patients had platinum doublet chemotherapy
4 patients had best supportive care partly due to age and concerns of the patient about impact of chemotherapy on quality of life.Result
2 patients who received chemotherapy died within 8 months of diagnosis.
2 patients who had BSC died within 5 months of diagnosis.
1 patient had 1 line of chemotherapy and then on PD recruited to PROMISE Trial and received Pembrolizamab. Still on treatment at C20.
3 patients who had chemotherapy are still alive on average 1yr 6 months post diagnosis with continuing stable disease.
3 of the patients who had first line chemotherapy went on to receive 2nd line chemotherapy either in or out of a clinical trial.
2 patients BSC still alive with average 6 months progression free survival.Conclusion
The results do suggest that patients who have chemotherapy do have an OS benefit when compared to those with BSC only. Overall patients tolerated chemotherapy well and have gone on to either receive second line oral Vinorelbine or be recruited into a clinical trial. Due to small numbers of patients it would be good to undertake a formal research study in multiple centres to recruit larger numbers of patients to assess if these results are mirrored nationally. It would also be of interest to identify if Sarcomatoid patients are routinely offered chemotherapy as first line treatment or whether the majority of patients are advised to accept BSC only.
WS03 - ITONF Workshop: Bridging the Gaps in Thoracic Oncology Nursing - A Global Perspective (Sign Up Required) (ID 104)
- Event: WCLC 2019
- Type: Workshop
- Track: Nursing and Allied Professionals
- Presentations: 1
- Now Available
- Coordinates: 9/07/2019, 11:00 - 18:00, San Francisco (2009)
WS03.08 - Panel - Emerging Therapies - Immunotherapy (Now Available) (ID 3673)
11:00 - 18:00 | Presenting Author(s): Rachel Thomas
IASLC Abstract for Presentation.
By Rachel Thomas
This panel session will focus on emerging immunotherapies, the aim is to bring the UK perspective to the panel particularly focusing on the role of the Lung Cancer Clinical Nurse Specialist (CNS) and how to support and counsel patients who are about to commence one of the new therapy combinations. The presentation from the UK will look at the current therapies in immunotherapy and then also look at two case studies which will bring the clinical trial data into real time perspective.
In the UK there have been no new immunotherapies launched, however, what the landscape of immunotherapies is changing in the UK for non-small cell lung cancer patients in the form of multi-drug combinations. Most recently we have seen the introduction of Durvalumab as a treatment for locally advanced unresectable non-small cell lung cancer post platinum based chemoradiation (1). This combination is still awaiting formal NICE approval but NHS patients can access this via a Cancer Drugs Fund. The PACIFIC Trial demonstrated that patients who received Durvalumab after platinum based chemoradiation had a significant improvement in their progression free survival when compared to chemoradiation plus a placebo. The median duration of progression free survival was 17.2 months in the Durvalumab arm compared to 5.6 months in the placebo arm. The median time to death or distant metastases was 28.3 months in the Durvalumab arm compared to 16.2 months in the placebo arm (2).
In the advanced metastatic setting there has recently been the introduction of the KEYNOTE-189 data which is looking at pembrolizamab + platinum/pemetrexed in patients who did not have any molecular mutations. This trial demonstrated an overall survival with a 51% reduction in the risk of death and superior progression free with a 48% reduction in the risk of progression or death.
In March 2019 The IMpower150 trial showed significant improvements in progression-free and overall survival with atezolizumab plus bevacizumab plus carboplatin plus paclitaxel (ABCP) versus the standard-of-care bevacizumab plus carboplatin plus paclitaxel (BCP) in chemotherapy-naive patients with non-squamous metastatic non-small-cell lung cancer who have an ALK rearrangement or who have an EGFR mutation. This combination has now been approved by NICE and will provide patients who progress on a tyrosine kinase inhibitor a multi-drug treatment combination which has been demonstrated in the Impower 150 trial to deliver overall survival of around 19.2 months when compared to bevacizumab/carboplatin and paclitaxel.
The UK has demonstrated the importance of the input of the Lung Cancer CNS in supporting patients who are about to commence treatment and also in proactively monitoring patients for potential adverse events (3). However, with the emergence of multidrug treatments how do we as Lung Cancer CNS’s assess which adverse events are related to the immunotherapy and which are related to the chemotherapy. Looking at the current clinical trial data from the studies above and then focusing on two real life patient case studies will provide some clear guidance on how to support patients whilst monitoring for any potential adverse events and dealing with these in a timely and accurate manner. The table below sets out just some of the main challenges faced in identifying immunotherapy related adverse events.
We as nurse specialists are now experienced at caring for patients on single agent immunotherapy treatments but one of the many challenges is that many lung cancer patients will have co-morbidities which can cloud the identification of immunotherapy adverse events. For example 40-70% of lung cancer patients will also have a diagnosis of COPD. Pneumonitis can present in a very similar pattern to organising pneumonia and chest infections meaning that accurate and detailed assessments are needed to ensure adverse events are identified and treated accordingly. However, when you also add into the treatment plan platinum doublet chemotherapy with or without radiotherapy the potential for adverse events increases, the panel will look at the PACIFIC data to assess the reporting of adverse events in this patient group. The panel will also then assess the trial data for platimum doublet chemotherapy and immunotherapy in the treatment of metastatic non-small cell lung cancer and whether this patient group with a potentially higher symptom burden reported an increase in the number of adverse events when compared to either single agent immunotherapy or platinum doublet chemotherapy alone.
One other important focus of the panel discussion will be to look at what the future treatment landscape for patients may be and how this will impact on progression free survival and living with lung cancer. This will mainly cover recent updates from ASCO and will aim to provide a flavour of what we may see coming into clinical practice in the coming months.
Durvalumab for treating locally advanced unresectable non-small-cell lung cancer after platinum-based chemoradiation. Technology appraisal guidance [TA578] Published date: 01 May 2019. https://www.nice.org.uk/guidance/TA578
Overall survival with Durvalumab after chemoradiotherapy in Stage III NSCLC. Scott. A; Augusto, V; Davey, D et al. www.nejm.org/doi/full/10.1056/NEJMoa1809697.
The National Lung Cancer Audit (2018) www.rcplondon.ac.uk/projects/national-lung-cancer-audit
Yoest JM (2017) Clinical features, predictive correlates and pathophysiology of immune related adverse events in immune checkpoint inhibitor treatments in cancer: a short review. Immunotargets Therapeutics. 6. P 73-82.