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MA13 - Going Back to the Roots! (ID 139)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
MA13.03 - Retrospective Study of Intrathecal Therapy for Non-Small Cell Lung Cancer (NSCLC) Patients with Leptomeningeal Carcinomatosis (Now Available) (ID 2086)
14:00 - 15:30 | Author(s): Monica Arellano
Leptomeningeal carcinomatosis (LMC) is a devastating cancer-related neurological complication with poor prognosis. In EGFR-mutant (mut) NSCLC patients (pts), osimertinib achieves high penetration into cerebral-spinal fluid (CSF) and promising efficacy. However, for EGFR-mut T790M-negative pts treated with prior 1st- and 2nd-generation tyrosine kinase inhibitors (TKI) and for driver negative NSCLC pts, a combination of intrathecal therapy (IT) and systemic therapy (ST) seems to be an appropriate approach. Our purpose is to explore the clinical outcome of IT combined with ST among NSCLC with LMC depending on EGFR status.Method
NSCLC pts with LMC treated with IT in our institution between 2010 and 2018 were retrospectively studied. After LMC diagnosis, intrathecal methotrexate (scheduled: 12mg twice weekly for 4 weeks, then 12mg weekly for 4 weeks) was given in combination with ST. A Kaplan-Meier survival analysis was performed for overall survival (OS) and progression free survival (PFS).Result
A total of 39 pts were included. Patient’s clinical characteristics are summarized in table 1. EGFR status was 17 mut (del19: 11pts); 11 wild-type (wt) and 11 unknown (unk). LMC and NSCLC diagnosis were more likely to be synchronous in EGFR wt compared with EGFR mut. The median follow-up from LCM diagnosis was 10.2 months. At the time of this analysis, only 6 pts were alive. Thirty-two pts received ST in combination with IT, 18 (46%) pts chemotherapy (6wt/ 3mut/ 9unk), while 14 (36%) pts an EGFR TKI (1wt/ 13mut). Clinical response (improvement of neurological symptoms and/or KPS) was seen in 11 (65%) EGFR mut pts vs 2 (18%) wt pts (p=0.033). Median OS and PFS for the whole cohort were 23 weeks (95%CI, 8.1 to 37.9) and 10 weeks (95%CI, 7.1 to 12.8) respectively. Median OS was higher for EGFR mut pts compared to wt pts, 38 weeks (95%IC 13.6-62.4) and 19 weeks (95%IC, 4.06-33.9) respectively, however this difference was not statistically significant (p=0.36) probably due to lack of statistical power.
Methotrexate-based IT given concurrently with systemic TKI may confer a higher clinical benefit and a trend toward OS benefit in NSCLC patients with LCM and EGFR activating mutations.
OA05 - Increasing the Impact of Nursing and Allied Health Professional Interventions in Lung Cancer Care (ID 130)
- Event: WCLC 2019
- Type: Oral Session
- Track: Nursing and Allied Professionals
- Presentations: 1
- Now Available
OA05.06 - Nursing Intervention on Immuno-Related Adverse Events in Lung Cancer Patients (Now Available) (ID 2135)
15:15 - 16:45 | Presenting Author(s): Monica Arellano
New treatment of immunotherapy permits to stimulate the patient’s immune responses against cancer. That it supposes a new strategy for melanoma, renal and lung cancers. Although, is different than Chemotherapy’s toxicity, the effect on tissues and organs are systemic and can be dealing to unpredictable side-effects that should be detected and treated as soon as possible. Nurses are vital to manage toxicity related to immunotherapy & educate and to provide patient’s with best education.
Our objetive is to describe lung cancer clinical nurses specialists’ role on the management of toxicities related to immunotherapy in lung cancer patients. How is the control and follow–up for those patientsMethod
In 2018, a cross-sectional study was conducted with lung cancer patients receiving immunotherapy at the Lung Functional Unit of Catalan Institute of Oncology, hospital Duran I Reynals in Barcelona-Spain. The variables included were socio-demographic profile, the clinical were; tumour histological, toxicities prevalence and severity and finally variables from the roles and references made by nurses. A descriptive analysis of prevalence was performed with type of toxicities and patient characteristics.Result
New patients receiving immunotherapy were 69 and the most common toxicities were; asthenia (82.5%), skin toxicity (35.5%), Pneumonitis (22.5%), colitis (20%), arthralgia (12.5%), endocrine toxicity (12.5%), emesis (10%), vascular (7.5%), gastritis (5%), hepatic (5%), renal (5%) & neurologic (5%). Attending grading severity, it was GI-GII, both were controlled by nurses, GIII and GIV required specialists, hospitalization and other professionals. Nurses visited 95% of the patients previously to initiate their treatments, attended 128 phone calls and in 111 patients they realised the follow-up and control. From total a 50% need emergency services and finally got hospitalization in 30% of them.Conclusion
Grades I and II are the most common toxicity. Nurses were in charge for patient education, providing careful information to patients, family members and caregivers, along the whole process. This role is vital to get better and earlier control on the side-effects, higher satisfaction and to facilitate the multidisciplinary team-working dynamic.