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Maria Lucia Reale



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    OA07 - Precision Medicine Involves Biology and Patients (ID 132)

    • Event: WCLC 2019
    • Type: Oral Session
    • Track: Advanced NSCLC
    • Presentations: 1
    • Now Available
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      OA07.07 - Quality of Life (QoL) Analysis in Lung Cancer: A Systematic Review of Phase III Trials Published Between 2012 and 2018 (Now Available) (ID 1958)

      11:00 - 12:30  |  Presenting Author(s): Maria Lucia Reale

      • Abstract
      • Presentation
      • Slides

      Background

      We previously reported that QoL is not included among endpoints and QoL results are underreported in a high proportion of phase III trials in oncology. Here we describe QoL prevalence and heterogeneity in QoL reporting in lung cancer phase III trials.

      Method

      We selected all primary publications of lung cancer phase III trials evaluating anticancer drugs published between 2012 and 2018 by 11 major journals. We analyzed QoL inclusion among endpoints, presence of QoL results and methodology of QoL analysis.

      Result

      122 publications were identified. In 39 (32.0%) publications, QoL was not listed among endpoints: 10/17 (58.8%) early stage/locally advanced NSCLC, 15/54 (27.8%) first-line of advanced NSCLC; 10/41 (24.4%) second and further lines of advanced NSCLC, 4/10 (40.0%) SCLC. Proportion of trials not including QoL was similar over time: 32.9% publications in 2012-2015 vs. 30.6% in 2016-2018. QoL was not listed among endpoints in primary publication in 16/80 (20.0%) for-profit trials vs. 23/42 (54.8%) no-profit trials. Out of 83 trials including QoL among endpoints, QoL results were not reported in 36 primary publications (43.4%). Proportion of trials not reporting QoL results in primary publication significantly increased over time (30.6% 2012-2015 vs. 61.8% 2016-2018, p=0.005). Overall, QoL data were not available in 65/122 (61.5%) primary publications, due to the absence as endpoint or unpublished results. QoL data were not available in primary publication in 48/80 (60.0%) for-profit trials vs. 27/42 (64.3%) no-profit trials. QoL data were lacking in 48/78 (70.6%) publications of trials with overall survival as primary endpoint, 27/54 (50.0%) with other primary endpoints and 28/54 (51.9%) publications with a positive result. For trials including QoL among endpoints but lacking QoL results in primary publication, probability of secondary publication was 6.3%, 30.1% and 49.8% after 1, 2 and 3 years respectively, without evidence of improvement in time to publication comparing 2012-2015 vs. 2016-2018. Out of 83 trials including QoL, most common tools were EORTC QLQ-C30 (42, 50.6%); EORTC LC13 (39, 47.0%); EQ-5D (37, 44.6%); LCSS (19, 22.9%); FACT-L (15, 18.1%). Out of 58 trials with available results, common methods of analysis were mean scores or changes (45, 77.6%), time to deterioration (31, 53.4%) and proportion of responders (19, 32.8%). Availability of a secondary QoL publication allowed a higher number of methods of QoL analysis (p<0.001).

      Conclusion

      QoL is not assessed in a high proportion of phase III trials evaluating lung cancer patients, a setting where attention to QoL should be particularly high, due to symptoms and limited life expectancy. Furthermore, the timely inclusion of QoL results in primary publications is worsening in recent years. Secondary publications allow a more complete description of QoL results, but imply a delay in their availability.

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    P2.14 - Targeted Therapy (ID 183)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Targeted Therapy
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.14-17 - Correlation Between Clinic-Pathological Data and T790M Detection in EGFR Mutated NSCLC Patients Progressing on 1st/2nd Generation TKIs (Now Available) (ID 2442)

      10:15 - 18:15  |  Author(s): Maria Lucia Reale

      • Abstract
      • Slides

      Background

      Despite osimertinib is moving to the first-line for advanced NSCLC harboring EGFR activating mutations, some patients still receive a frontline first- or second-generation EGFR-TKI. In this setting, factors predicting the emergence of T790M resistance mutation at progression (PD) are lacking. The aim of this retrospective study was to investigate the correlations between clinic-pathological features and T790M positivity (T790M+) in a single-center cohort of EGFR mutated stage IV or recurrent NSCLC patients, who underwent liquid (LB) or tissue biopsy (TB) at PD when treated with first- or second-generation EGFR-TKIs.

      Method

      Data from 122 patients (80 female, 42 male) treated between 2012 and 2019 were considered for the analysis. EGFR mutations were detected with real time-polymerase chain reaction (RT-PCR) on LB and pyrosequencing or next generation sequencing on TB. PD was determined by RECIST 1.1 criteria. Univariate analysis by Fisher exact test was performed to assess any association.

      Result

      At diagnosis, 117 patients carried common EGFR mutations (84 exon 19 deletions; 33 exon 21 mutations), 5 had rare mutations (3 exon 18 mutations; 2 exon 20 mutations other than T790M) . At PD, 29 patients (24%) underwent only LB, 29 only TB (24%), 64 both (52%). The overall T790M+ rate was 67% (82/122). T790M+ was significantly higher among patients with exon 19 deletion than in those with exon 21 mutation (77% vs 51%, p=0.008). T790M+ was significantly more frequent in patients with exclusively intrathoracic PD as compared to extrathoracic PD (81% vs 56%, p=0.007). Patients with pleural involvement (PI), considered as pleural effusion or/and pleural disease, as site of PD (n=45) had a significantly higher frequency of T790M+ than those with stable or absent PI (n=77) (82% vs 58%, p=0.009), irrespectively of the pattern of PD. No correlation with other sites of PD was found.

      Conclusion

      Exon 19 deletion, intrathoracic PD and PI as site of PD are significantly associated with higher frequency of T790M+ in patients progressing to first-or second-generationEGFR-TKIs. These results, if confirmed by an independent validation cohort, may allow the development of a T790M+ predictive score accounting for type of mutation and sites of progression.

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