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Lucia Milla Collado

Moderator of

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    ES25 - Liquid Biopsy (ID 27)

    • Event: WCLC 2019
    • Type: Educational Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 4
    • Now Available
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      ES25.01 - Liquid Biopsy: State of the Science (Now Available) (ID 3287)

      14:30 - 16:00  |  Presenting Author(s): Eloisa Jantus-Lewintre

      • Abstract
      • Presentation
      • Slides

      Abstract

      I. The present.

      Molecular diagnosis in cancer certainly requires the analysis of a tumor biopsy. However, in lung cancer, there is still a 20- 30% of tissue failure rates for tumor genotyping in routine pathological samples. As a consequence, liquid biopsy (LB) has emerged as a valid alternative source of information for the analysis of tumor specific alterations. LB refers to specimens obtained from body fluid such as blood, urine, saliva, cerebrospinal fluid, among others.

      In the complex matrix represented by blood, the main clinical developments have focused on the analysis of: i) circulating tumor DNA (ctDNA), which represents a small part of cell free circulating DNA released from tumor cells and, ii) circulating tumor cells (CTCs), defined as disseminated cancer cells in the bloodstream. Each of these materials offers unique opportunities to test different biomarkers and to analyze characteristics of the tumors.

      The advantages of the use of blood samples are clear: i) it is a minimally invasive way to get relevant tumor information, ii) serial samples can be obtained capturing tumor evolution in real time, iii) LB abrogates the limitations associated with tumor heterogeneity, since nucleic acids or tumor cells present in circulation recapitulate the information belonging from different tumor locations (primary tumor and metastases), iv) the development of new sensitive assays for analyses of ctDNA and CTCs allow the assessment of minimal residual disease and v) the costs of LB analysis are comparable with other molecular biology techniques already used in the clinical setting in addition to the reduced risks of complications associated with tissue biopsy. All these factors accelerated the implantation of LB in the clinical practice in oncology in several scenarios, especially in lung cancer.

      I.1.Lung Cancer. Clinical applications of liquid biopsies.

      At present, LB is no longer a promise but a reality allowing better treatment selection, real-time monitoring of lung cancer patients and early detection of acquired resistances. Figure 1 highlights the biological basis of LB as a source for biomarkers analysis and key clinical applications in lung cancer.

      •Personalized therapeutics/ Resistance detection: regarding the detection of tumor-associated genetic alterations in LB samples, there are a lot of scientific data demonstrating similar response rates to targeted therapies than the obtained in tissue biopsies. In particular, in the context of NSCLC patients with progressive or recurrent disease during treatment with TKIs, the IASLC guidelines suggest the use of LB-first algorithm to detect resistance mechanism.

      For those lung cancer patients receiving immune-based therapeutic treatments, recent data show that assessment of tumor mutational burden in plasma (bTMB) correlated with the values found in tissue and predicts efficacy of immune-checkpoint inhibitors.

      •Detection of minimal residual disease: Persistent detection of ctDNA or CTCs after local therapy or after adjuvant treatments was found associated with poor clinical outcome. In this particular clinical setting it is important to highlight that sensitivity of the methods used for ctDNA or CTCs evaluation really matters.

      •Real-time monitoring of disease: this is one of the most interesting application of LB, since tissue biopsies are intrinsically unable to capture tumor heterogeneity while ctDNA can comprehensively recapitulates clonal evolution over time, allowing to early detect and track the emergency of resistance mutations.

      II. The future.

      Current assays for LB analysis do not meet all the needs required for the fully implementation of the Precision Oncology. There is still room for improvement to reach its maximum informative potential. Hopefully, studies on exosomes, platelets, cfRNAs, metabolites, will help to have a more integrative picture of tumor status at each time it is evaluated.

      One of the clinical applications in which LB is called to play a key role is in the screening and early detection of lung cancer. In this regard, there are some interesting data coming from multiparametric (DNA and protein) plasma analysis. However, caution is required since there are still some important issues, such as clonal hematopoiesis, that need to be further considered.

      Another important challenge for LB is standardization. It is necessary to cross-validate platforms, standardize pre-analytical issues, compare sensitivity of different methodological approaches and also to work in the harmonization of bioinformatic tools for data analysis.

      It is clear that in the near future, tests based on the analysis of "liquid biopsies" will be more generalized, offering complementary information to tissue biopsies and providing valuable information to early diagnose lung cancer, to detect molecular progressions even prior to radiographic or clinical progression and as a source for real-time treatment monitoring.

      References

      Alix-Panabières C, Pantel K. Clinical Applications of Circulating Tumor Cells and Circulating Tumor DNA as Liquid Biopsy. Cancer Discov. 2016;6(5): 479-91.

      Bardelli A, Pantel K. Liquid Biopsies, What We Do Not Know (Yet). Cancer Cell. 2017; 31(2):172-179.

      Bettegowda C, Sausen M, Leary RJ, et al. Detection of circulating tumor DNA in early- and late-stage human malignancies. Sci Transl Med. 2014;6(224):224ra24

      Calabuig-Fariñas S, Jantus-Lewintre E, Herreros-Pomares A, Camps C. Circulating tumor cells versus circulating tumor DNA in lung cancer-which one will win? Transl Lung Cancer Res. 2016; 5(5):466-482

      Heitzer E, Haque IS, Roberts CE, Speicher MR. Current and future perspectives of liquid biopsies in genomics-driven oncology. Nat Rev Genet. 2019;20(2):71-88.

      Pantel K, Alix-Panabières C. Liquid biopsy: Potential and challenges. Mol Oncol. 2016; 10(3):371-3.

      Rossi G, Ignatiadis M. Promises and Pitfalls of Using Liquid Biopsy for Precision Medicine. Cancer Res. 2019;79(11):2798-2804.

      Siravegna G, Marsoni S, Siena S, Bardelli A. Integrating liquid biopsies into the management of cancer. Nat Rev Clin Oncol. 2017;14(9):531-.548

      figure 1.png

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      ES25.02 - Liquid Biopsy: Utility for Surveillance in Early Stage (Now Available) (ID 3288)

      14:30 - 16:00  |  Presenting Author(s): Lecia Sequist

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      ES25.03 - Leveraging the Quantitative Nature of Cfdna Genotyping for Lung Cancer Care (Now Available) (ID 3289)

      14:30 - 16:00  |  Presenting Author(s): Cloud P Paweletz

      • Abstract
      • Presentation
      • Slides

      Abstract

      Nearly 70 years after the discovery of free-floating DNA in the blood, also known as cell free DNA (cfDNA) (1), plasma genotyping of cfDNA is transforming cancer care with promise in non-invasive genotyping, early diagnosis, and disease prognostication by detection of minimal residual disease (MRD). At present the most widespread use of cfDNA in lung cancer is detection of mutations in EGFR and KRAS or re-arrangements in ALKand ROS1 in the metastatic setting. In fact, the only FDA approved liquid biopsy test among all cancers is Roche’s Cobas plasma EGFR mutation test for non-small cell lung cancer. (NSCLC) (2), while many diagnostic companies have developed PCR or next generation sequencing (NGS) laboratory developed tests that are commonly reimbursed by payors in house. Next-generation sequencing (NGS) permits broader inquiries, allowing assessment of the mutation status of thousands to millions of bases.

      The use of cfDNA in early cancers is confounded by the fact that early detection demands ultra-sensitive assays of low abundant biological markers. As proof of concept Bettegowda et al. performed digital PCR on cfDNA of 640 cancer patients of varying cancer type and stage. Intriguingly they found that rates of tumor DNA differed by tissue of origin, and 47% of stage I cancers and 55% of stage II cancers had detectable circulating tumor DNA (ctDNA) (3). An observation that as we and others have confirmed is a main source for false negatives (4). At present, NGS efforts are focused either on targeted approaches using either barcoded targeted amplicon (TAmSeq) or hybrid capture approaches (CAPP-Seq) covering 10Mb to 50Mb at reported sensitivities of 0.01% to 0.50% for fit for purpose build NGS assays. However, pushing assay sensitivity increases false positives.

      Recently, we and other have found that false positives are reported in many commercial assays and are routinely attributed to ‘tumor heterogeneity’ . These can be attributed to DNA shed from normal cells, including germline variants or non-cancerous somatic variants from clonal hematopoiesis (CH) (5-8). The latter is particularly challenging because CH can involve cancer-associated genes (e.g. TP53, JAK2, KRAS). To limit false positives and to investigate the common link between cancer-related mutations within the blood and underlying malignancies broad sequencing of cfDNA should also detect other cancer-related mutations, such as inactivating mutations in tumor suppressors and include assaying of the patients blood cells to filterout germlines. Thus, deep and broad sequencing could provide sensitivity needed to detect low levels of cfDNA alterations in early stage patients. Indeed, Abbosh et al. perform multi region whole-exome sequencing of early-stage NSCLC tumors to show an abundance of clonal mutations in these tumors (9). Abbosh and colleagues provide an intriguing solution to this issue by requiring the detection of two or more SNVs for the determination of the presence of cancer.In this presentation we present factors affecting ultras sensitive assays with particular emphasis on interpretation of commercial tests and future use of cfDNA assays in early cancers.

      1. Mandel P and Metais P. Les acides nucleiques du plasma sanguin chez l’homme [in French]. C R Seances Soc Biol Fil 1948;142:241-243.

      2.Center for Drug Evaluation and Research. Approved Drugs - cobas EGFR Mutation Test v2 [Internet]. U S Food and Drug Administration Home Page. Center for Drug Evaluation and Research; Available from: https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm504540.htm

      3.Bettegowda C, Sausen M, Leary R, Kinde I, Agrawal N, Bartlett B, et al. Detection of Circulating Tumor DNA in Early and Late Stage Human Malignancies. Science Translational Medicine 2014;16:224ra24.

      4. Oxnard GR, Thress KS, Alden RS, et al: Association Between Plasma Genotyping and Outcomes of Treatment With Osimertinib (AZD9291) in Advanced Non–Small-Cell Lung Cancer. Journal of Clinical Oncology 34:3375–3382, 2016

      5.Hu Y, Ulrich BC, Supplee J, et al: False-Positive Plasma Genotyping Due to Clonal Hematopoiesis. Clin Cancer Res 24:4437-4443, 2018

      6.Hu Y, Alden RS, Odegaard JI, et al: Discrimination of Germline EGFR T790M Mutations in Plasma Cell-Free DNA Allows Study of Prevalence Across 31,414 Cancer Patients. Clin Cancer Res 23:7351-7359, 2017

      7.Slavin TP, Banks KC, Chudova D, et al: Identification of Incidental Germline Mutations in Patients with Advanced Solid Tumors Who Underwent Cell-Free Circulating Tumor DNA Sequencing. Journal of Clinical Oncology 36:3459-3465, 2018

      8.Oxnard GR, Tara M, Earl H, et al. Genome-wide sequencing for early stage lung cancer detection from plasma cell-free DNA (cfDNA): The Circulating Cancer Genome Atlas (CCGA) study. Journal of Clinical Oncology : LBA8501-LBA8501, 2018

      9.Abbosh C, Birkbak NJ, Wilson GA, Jamal-Hanjani M, Constantin T, Salari R, et al. Phylogenetic ctDNA Analysis Depicts Early Stage Lung Cancer Evolution. Nature 2017;545:446-451.

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      ES25.04 - Liquid Biopsy: Utility for Early Detection (Now Available) (ID 3290)

      14:30 - 16:00  |  Presenting Author(s): Ana Vivancos

      • Abstract
      • Presentation
      • Slides

      Abstract

      Personalized treatment according to molecular profile is standard of care in advanced NSCLC patients. Epidermal Growth Factor Receptor (EGFR) activating mutations predict sensitivity to first- and second-generation anti-EGFR tyrosine kinase inhibitors (TKIs) in patients with non-small cell lung cancer (NSCLC). However, obtaining a tissue biopsy remains a limitation in NSCLC patients. Liquid biopsy is a non-invasive method that allows the detection and quantification of tumor somatic mutations in plasma, although around 20% of all tumors don’t appear to shed DNA into the bloodstream. Here, we aimed to correlate the presence and amounts of ctDNA in plasma of NSCLC patients with several clinical parameters, as well as obtaining serial data on non-shedding patients throughout their course of illness.

      We collected 280 serial blood samples of 40 patients with NSCLC diagnosis harboring EGFR sensitizing mutations in their tumor biopsy. Extracted ctDNA was tested for five common EGFR mutations (exon 19 deletion, L858R, L861Q, T790M and C797S) by highly sensitive and quantitative Droplet Digital PCR (ddPCRTM; Bio-Rad), at a limit of detection between 0.1-0.5% and quantified the percentage of mutant alleles of EGFR. Of these patients, 16 provided one plasma sample (32%) and the other 34 (68%) provided multiple blood collections with an average of 5 follow-up plasma samples. All patients received targeted TKI therapy before or during the study. Lines of treatment, Progression free survival (PFS) and overall survival (OS) were annotated for each patient in the cohort.

      Out of the 40 patients evaluated, we detected presence of baseline ctDNA in 32 patients (80%). Such parameter was independent of the sensitizing mutation; tumors harboring exon 19 or exon 21 mutation tend to equally shed DNA into the bloodstream (78% and 80%, respectively). After a median follow up of 36.1 months, and immature survival data, the PFS and OS are higher among patients with baseline ctDNA positive compared to patients without ctDNA detected: 22 months vs. 13.6 months and 35 vs. 24 months, respectively. T790M and C797S resistance mutations were detected at different prevalences, depending on the TKI treatment regimen, and were always subclonal in plasma as compared to the clonal EGFR mutation (indel 19/L858R). We observed that, for the whole period analyzed in non-shedding patients, ctDNA was never detected.

      In our series, sensitizing EGFR mutations in plasma were identified in 80% of the patients by ddPCR. Acquired resistance mutations in EGFR appeared to be subclonal, which might impact detection in liquid biopsy. Shedding is a complex biological entity that warrants further research in order to improve our understanding on its impact in prognosis.

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Author of

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    EP1.03 - Biology (ID 193)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Biology
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.03-04 - Analysis of Post-Surgical Systemic Inflammatory Indexes After Non-Small Cell Lung Cancer Surgical Intervention (ID 1135)

      08:00 - 18:00  |  Presenting Author(s): Lucia Milla Collado

      • Abstract
      • Slides

      Background

      High NSCLC´s mortality rates pushes the research of new prognostic indexes further tan TNM staging and could help in better treatment´s selection. Neutrophil-Lymphocyte Ratio (NLR) preoperatively determined has demonstrated its relation with the immunologic status of the patient prior to the intervention and its capacity of “beating” tumor growing and its prognostic influence.

      OBJECTIVE: Evaluate the prognosis influence of NLR, Lymphocyte-Monocyte Ratio (LMR) and Platelet-Lymphocyte Ratio (PLR) in patients who underwent surgery for NSCLC with R0 resection and abscence of neoadjuvant treatment in peripheric blood determinations after surgery.

      Method

      A retrospective review of all consecutive patients operated on stage I to IIIA NSCLC from may 2014 – october 2018, completely resected and with no neoadjuvant treatment. Patients with previous oncologic history, haematologic neoplasms, perioperatory blood transfussion, perioperative infections or corticosteroids treatment were excluded. Peripheral blood determinations were taken during the first 6-months follow-up period.

      NLR, LMR and PLR were calculated.

      A descriptive analysis of demographic, tumor and surgical details is done.
      Overall survival (OS) was calculated since the date of surgery to date of death or last follow-up date. Disease-free survival (DFS) was calculated since the date of surgery to the date of recurrence. The discrimination capacity of the ratios was assessed with the calculation of the area under the ROC curve [AUC (CI 95%)].

      The relationship among relevant clinico-pathological variables, DFS and OS was calculated. Analysis of recurrence risk factors with univariate and multivariate binary logistic regression (LR) OR(95%CI) was performed.

      Result

      86 patients were included in the analysis. Median follow-up time was 45.7 months. Median OS and DFS were 27 and 24 months respectively. The AUC values of NLR [0.59(0,44-0,74)] and PLR [0,61(0,45-0,76] were not statistically significant, but value of LMR was significant with [0,70(0,57-0,83)].

      The LR model found as factors associated with a higher probability of recurrence adjusted by sex and age: the value of LMR with OR=0,38 (0,20-0,73) and a higher stage than the OR=11,3 (1,89-67.5).

      Conclusion

      Conversely to other publications, in our study the results showed the only relationship between LMR, tumor stage and risk of recurrence.

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      EP1.03-21 - Circulating Tumor Cells Isolation Is Not a Useful Prognostic Tool for Non-Small Cell Lung Cancer Patients Candidates to Surgical Treatment (ID 1271)

      08:00 - 18:00  |  Presenting Author(s): Lucia Milla Collado

      • Abstract
      • Slides

      Background

      It is well known that prognostic stratification according to TNM classification of non-small cell lung cancer (NSCLC) patients is somehow imprecise as there exist notable differences among patients endorsed in the same staging. Because of this it is mandatory to find complementary tools to reach a more accurate classification in order to the best selection of treatments for every patient. The presence of circulating tumor cells (CTC) in periferic blood samples has showed worse prognosis in other primary tumors. The aim of this study is analyzing the impact of CTC on disease free survival (DFS) and overall survival (OS).

      Method

      Periferic blood samples from 28 patients diagnosed with NSCLC in early stages candidates for surgical treatment were obtained. Study period was from June 2011 to October 2013. Blood samples were obtained at least at three different moments: before surgery (S1), one year after the operation (S2) and the last one 2 years after the operation (S3). Blood samples were analyzed by CellSearch method.

      Probability of survival was calculated following the Kaplan-Meier method; differences in survival were examined by the Long-Rank test.

      Result

      Median OS was 34 months and DFS was 11 months. There was no statistically significant differences among patients with or without CTC in S1, S2 and/or S3. When CTC were present, no relationship was observed between the variations in the number of CTCs among the different blood samples and the OS and DFS.

      Conclusion

      In our study, the presence of CTCs in any of the blood samples obtained during the follow-up showed no relationship with OS and DFS. The same results were observed in relation to variations of CTCs' count.

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    MA16 - Prioritizing Use of Technology to Improve Survival of Lung Cancer Subgroups and Outcomes with Chemotherapy and Surgery (ID 142)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
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      MA16.07 - Implementation of a Smartphone App to Face Postoperative Period in Patients with NSCLC Undergoing Lung Resection Surgery (Now Available) (ID 1028)

      15:45 - 17:15  |  Author(s): Lucia Milla Collado

      • Abstract
      • Presentation
      • Slides

      Background

      Preoperative patient education and counseling helps to set expectations about surgical procedure and to prepare for it. Thoracic surgery procedures are related to postoperative complications and strategies to reduce them begin prior to surgery. Lung expansion maneuvers, the importance of early ambulation and pain control are best taught before the procedure. The aim of this prospective study was to implement the use of a smartphone application in a cohort of patients undergoing lung resection surgery and describe their feedback results.

      Method

      We created a Smartphone application as a multidisciplinary tool including: peri-operative medical advice (stop smoking, mouth health, early mobilization and pain control) (Fig1), ten chest physical exercises (with animated images) and programmable Smartphone daily notifications. Complete information to download, set up and interaction with the software was given to patients. A Multiple-Choice-Question survey was applied to patients at the moment of hospital discharge in order to evaluate their experience. This prospective and observational study included clinical data and results of surveys applied.

      image1 (3).png

      Result

      A total of 68 patients interacted with the application before surgery and answered the survey after the procedure. Median age was 66.5 years and 67.6% were males. Of them, 51 patients (75%) considered the content “very compressible”. 54 patients (79.4%) considered “positive” the contribution of the application to face the postoperative period. Additionally, 31 patients (45.6%) deemed “appropriate” the quantity of time and physical effort needed to complete the interaction with the tool and reach the goals.

      Conclusion

      This is the first smartphone application created by thoracic surgeons to improve patient´s education and helps them to prepare for surgery. This new technological tool was successfully implemented in our thoracic surgery department. For patients, it is easy to download, setup and contents comprehensible information that contributes to face positively the postoperative period with an adequate physical effort and quantity of time.

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    P1.03 - Biology (ID 161)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Biology
    • Presentations: 2
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.03-43 - Preoperative Prognostic Value of Immune-Inflammation Index in Patients with Operable Non-Small Cell Lung Cancer (Now Available) (ID 50)

      09:45 - 18:00  |  Author(s): Lucia Milla Collado

      • Abstract
      • Slides

      Background

      There is increasing evidence that the systemic immune-inflammation response is correlated with clinical outcomes in diverse solid tumors. The aim of the study was to determine preoperative values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR), and to analyze their impact on histologic outcomes and prognosis in patients with operable non-small cell lung cancer (NSCLC).

      Method

      Retrospective study of patients diagnosed of stage I-IIIA NSCLC (7th edition TNM) between May 2014 and October 2018. Exclusion criteria included neoadyuvant therapy, R1-R2 resection, previous autoimmune or hematological disorders, active pre- or postoperative infection, steroid therapy, perioperative blood transfusion and previous history of malignancy other than NSCLC. The NRL, PLR and LMR were calculated by means of a peripherical blood sample 4 weeks prior to surgery. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values for above mentioned ratios. The association between NRL, PLR and LMR, and histological outcomes, recurrence, disease free interval (DFI) and overall survival were analyzed.

      Result

      Eighty-six patients who underwent surgery for NSCLC were included in this retrospective analysis (51% males, median age 69,5 years). Mean follow-up was 45,7 months. Median overall survival and DFI were 27 and 24 months respectively. There was no statistically significant association between PLR, MLR, and histological variables, DFI or overall survival. The optimal cut-off value was 1.90 for NLR. In our series, INR values superior to 1.90 showed a significantly higher recurrence rate (23.6% vs. 5.5%, p=0.04) (Fig. 1) and a decreased overall survival (90% vs. 97%, p=0.031).

      graphic1.jpg

      Conclusion

      This study demonstrated that NLR is an independent poor outcome marker for patients with I-IIIA NSCLC who underwent surgery. In our series NLR (cut off value >1.90) could be used preoperatively as a valuable prognostic marker for disease free interval and overall survival.

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      P1.03-45 - Circulating Tumor Cells' Clearance in Blood Samples After Chemotherapy: A Good Prognostic Factor for OS in Advanced NSCLC (ID 1277)

      09:45 - 18:00  |  Presenting Author(s): Lucia Milla Collado

      • Abstract
      • Slides

      Background

      The poor prognosis of patients diagnosed with non-small cell lung cancer (NSCLC) patients in advanced stages requires a close monitoring of treatment´s response in order to plan early changes when necessary. The presence of circulating tumor cells (CTC) in periferic blood samples has showed worse prognosis in different tumors.

      The aim of the study is analyzing the relationship between the presence of CTCs in periferic blood samples and overall survival (OS) and progression-free interval (PFS) in advanced stages of NSCLC patients.

      Method

      Periferic blood samples were obtained from 25 patients diagnosed with NSCLC in advanced stages from April of 2010 to January of 2013 suitable for chemotherapy treatments. One blood sample was taken before treatment (S1) and the other one, after one cycle of chemotherapy (S2). Blood samples were analyzed by CellSearch method.

      Probability of survival was calculated following the Kaplan-Meier method; differences in survival were examined by the Long-Rank test.

      Result

      Median OS and PFS were 10 months and 6 months respectively.

      OS was 6 months in patients with isolation of CTC in S1 vs 11 months in those with no isolation of CTC; no statistical differences (p=0.978).

      OS was longer in those patients in whom there was no isolation of CTC in S2 compared to those in whom CTC were isolated (19 months vs 5 months; p=0.006). Contrary to this, no difference was observed considering PFS with a median of 6.5 months in patients without CTCs in their S2 and 6 months with CTCs present.

      untitled.jpg

      Conclusion

      In our study, patients with CTC´s isolation in S2 had a worse prognostic, median of 14 months OS, compared to those in whom there were no CTC isolation.

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    P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.16-42 - The Use of a Smartphone Application Improves Postoperative Outcomes in Patients Undergoing Lung Cancer Resection (Now Available) (ID 1462)

      10:15 - 18:15  |  Author(s): Lucia Milla Collado

      • Abstract
      • Slides

      Background

      For early stages of lung cancer, complete surgical resection with curative intent for patients who are surgical candidates remains the most effective treatment. However, thoracic surgery procedures are related to postoperative pulmonary complications which increase the morbidity and mortality. Preoperative pulmonary rehabilitation programs improve postoperative outcomes. This study aims to evaluate the role of a smartphone application to improve pulmonary rehabilitation in a group patients scheduled for lung cancer resection.

      Method

      A Smartphone application containing peri-operative medical advice (stop smoking, mouth health, early mobilization and pain control) and ten chest physical exercises (aerobic exercise, inspiratory muscle strength and secretion mobilization technique) was created. This prospective and no randomized study was developed between January 2017 and December 2018. All patients scheduled for surgery were asked to participate. A group of 68 patients used and interacted with the software before and after the surgery. The control group (114 patients) received classical information and education by the Department of Physical Medicine and Rehabilitation. Clinical-pathological variables, incidence of postoperative pulmonary complications, duration of chest drainage, length of hospital stay and 30 days mortality rate were recorded and analyzed.

      Result

      Postoperative pulmonary complications were developed 17.6% in the intervention group and 33.3% in the control group (P=0.02). The length of hospital stay was shorter in the intervention group (median 3±4.09d vs. 5±6.87d P=0.001). No differences were found in duration of chest drainage or 30 day mortality compared with control group.

      Conclusion

      This new technological resource created by thoracic surgeons demonstrates that preoperative rehabilitation program and patient education improve postoperative outcomes in patients undergoing lung cancer resection, decreasing the incidence of postoperative pulmonary complications and length of hospital stay.

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