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Telma Costa



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    EP1.01 - Advanced NSCLC (ID 150)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.01-24 - Lung Adenocarcinoma: Mutational Profile in Ever Smokers and Non-Smokers Patients (ID 2847)

      08:00 - 18:00  |  Author(s): Telma Costa

      • Abstract
      • Slides

      Background

      Lung cancer occurring in never-smokers had become a distinct entity. This study aims to evaluate the mutational profile in ever smokers and non-smokers patients with pulmonary adenocarcinoma.

      Method

      Retrospective analysis (Oct-2016 to Aug-2017) of patients diagnosed with pulmonary adenocarcinoma in our pulmonology department.

      Next generation sequencing (NGS) was used to identify different mutations and translocations. Pathological variants of genes and variants of uncertain clinical significance were included.

      Result

      60 patients were enrolled in this study: 18 (30%) non-smokers and 42 (70%) ever smokers.

      In 72.2% of non-smokers and 57.1% of ever smokers were identified at least one mutation. Despite this, ever smokers had an overall higher frequency of mutations (72.6% vs 27.4%) because many patients had concomitant mutations.

      Although not statistically significant, ever smokers had more mutations that are variants of uncertain clinical significance (40% vs 23.5%; p=0,227)

      Table 1. Frequency of mutations

      ___ Non-smoker Ever smokers
      Mutated gene

      Pathological variants

      (n)

      Variants of uncertain clinical significance (n)

      Pathological variants

      (n)

      Variants of uncertain clinical significance (n)
      KRAS 3 0 18 0
      EGFR 5 0 4 5
      ERBB4 0 0 0 1
      MET 0 1 0 3
      PTEN 0 0 1 1
      HER2 1 2 0 7
      PI3KCA 0 1 1 1
      BRAF 0 0 1 0
      ROS 1 0 1 0
      ALK 3 0 1 0
      Total 13 4 27 18
      Conclusion

      Although not statistically significant, smokers and non-smokers appear to have a different mutational profile. Smokers have a higher rate of concomitant mutations, although some of them are variants of uncertain clinical significance. NGS will help to increase knowledge about the mutational profile in these patients.

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      EP1.01-80 - Progressive Disease with T790M Mutation vs Non-T790M Mutation in EGFR Positive Patients Treated with Tyrosine Kinase Inhibitors (ID 2781)

      08:00 - 18:00  |  Author(s): Telma Costa

      • Abstract
      • Slides

      Background

      Patients with metastatic non-small cell lung cancer (NSCLC) with a sensitizing EGFR mutation are candidates for treatment with a tyrosine kinase inhibitor (TKI), but acquired resistance is inevitable. The most frequent mechanism of acquired resistance to TKI is the T790M mutation.

      Method

      Retrospective analysis of patients with EGFR mutation treated with TKI who progressed from November 2016 to July 2018, for whom the T790M mutation testing was done through liquid or tissue biopsy.

      Result

      Progression disease was observed in 18 patients. The mean age was 67.1 ± 14.4 years. Twelve patients (66.7%) were female. Ten patients (55.5%) presented the T790M mutation as a resistance mechanism to TKI.

      T790M positive T790M negative p value

      Non-smokers

      Ever smokers

      9 (90%)

      1 (10%)

      2 (25 %)

      6 (75 %)

      0.005

      EGFR mutation

      Exon 18

      Exon 19

      Exon 21

      0 (0%)

      8 (80%)

      2 (20%)

      1(12.5%)

      5(62.5%)

      2 (25%)

      0.604

      Initial TKI

      Gefitinib

      Afatinib

      Erlotinib

      2 (20%)

      0 (0%)

      8 (80%)

      2 (25%)

      3(37.5%)

      3(37.5%)

      0.146

      Response evaluation

      Stable disease

      Partial response

      3 (30%)

      7 (70%)

      6 (75%)

      2 (25%)

      0.119
      PFS with initial TKI - months (mean ± SD) 11 ± 5.3 10 ± 6.9 0.586
      Months treated with initial TKI after disease progression due to clinical benefit (median - IQR) 2 - 5 4 - 3 0.409

      Progressive disease

      Increase of primary lesion size

      Increase of metastasis size

      New intrathoracic lesions

      New extrathoracic ± intrathoracic lesions

      3 (30%)

      3 (30%)

      2 (20%)

      2 (20%)

      3(37.5%)

      2 (25%)

      0 (0%)

      3(37.5%)

      0.465

      Conclusion

      The T790M mutation was the most frequent mechanism of TKI resistance. Non-smokers developed the mutation more often than ex-smokers, although this result was not statistically significant. In the other analyzed variables there were no statistically significant differences.

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    EP1.04 - Immuno-oncology (ID 194)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Immuno-oncology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.04-10 - Nivolumab in Non-Small Cell Lung Cancer (NSCLC): A Real-Life Study (ID 2012)

      08:00 - 18:00  |  Author(s): Telma Costa

      • Abstract
      • Slides

      Background

      Immunotherapy is an option in locally advanced or metastatic lung cancer (LC), depending on the PD-L1 value. Nivolumab, an anti-PD1 immunological checkpoint inhibitor, can be used in LC in subsequent lines, regardless of the PD-L1 value. The aim of this study was to analyze patients with LC treated with nivolumab in the Multidisciplinary Thoracic Tumor Unit (MTTU) of our hospital.

      Method

      Retrospective analysis of patients treated in the MTTU of our hospital who with nivolumab in subsequent lines between Dec-2015 and Dec-2018.

      Result

      49 patients were enrolled in this study with a mean age at the start of immunotherapy of 62.1 ± 9.1 years. 38 patients (77.6%) were male. Regarding the histological type, 30 (61.2%) were adenocarcinomas, 16 (32.7%) squamous cell carcinomas and 3 (6.1%) corresponded to other histological types. Regarding the expression of PD-L1, 30 patients (61.2%) had no expression, 13 (26.5%) had PD-L1 ≥1%, and in 6 patients (12.2%) this parameter was unknown. 27 patients (55.1%) were treated with 1 prior therapeutic line, 12 patients (24.5%) with 2 and 10 patients (20.3%) with > 2 previous therapeutic lines. With immunotherapy, 7 (14.3%) had partial response, 22 (44.9%) stable disease and 12 (24.5%) progressive disease. 28 patients (57.1%) have died so far.

      The median PFS was 5 months (95% CI 1.4-8.6) and the median overall survival (OS) was 10 months (95% CI 7.6-12.4). There were no significant differences between patients with or without PD-L1 expression.

      Conclusion

      The OS of our patients treated with nivolumab was slightly lower than some literature which perhaps is related to the fact that this is a real-life study, patients had a high number of previous therapeutic lines and there were different histologic types of LC.

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    EP1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 206)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 2
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.16-16 - Pembrolizumab as First Therapeutic Line in Non-Small Cell Lung Cancer – The Experience of a Portuguese Tertiary Hospital (Now Available) (ID 2895)

      08:00 - 18:00  |  Author(s): Telma Costa

      • Abstract
      • Slides

      Background

      Pembrolizumab is a humanized monoclonal antibody against PD-1 that has antitumoral activity in NSCLC. It is currently approved by the EMA for the treatment of patients with advanced NSCLC with PD-L1 expression ≥50%.

      Method

      A retrospective study was performed in patients with advanced NSCLC proposed for first-line treatment with pembrolizumab. These patients were recruited at our Thoracic Tumor Unit between June 2017 and December 2018. An epidemiologic characterization of patients was performed and a progression-free survival (PFS) was analysed through the Kaplan-Meier method.

      Result

      Twenty-two patients were included, with one being excluded due to the presence of synchronous tumor lesions. The majority of patients were male (90,5%), with a mean age of 63±13 years and 85.7% were smokers or former smokers. At the start of immunotherapy, 23.8% had a PS0 and 76.2% had a PS1. The most frequent histology was adenocarcinoma (57.1%), followed by squamous cell carcinoma (33.3%), and the majority of patients were in stage IV (95.2%). The median of PD-L1 expression was 80% (IQR 30).

      Partial remission was achieved in 47.6% of patients, stable disease in 28.6%, and 23.8% of patients had progressive disease. The median PFS was 10.0 months. Adverse effects were documented in 28,6% of patients, namely hypothyroidism, colitis, hepatitis and sialadenitis. Only one was classified as grade 3 according CTCAE, leading to interruption of the drug.

      Conclusion

      The PFS obtained in our study was similar to that described in literature (10.3 months). As we can observe the safety profile of pembrolizumab was also good. Thus, pembrolizumab is increasingly being shown as a well-established drug in 1st line for advanced NSCLC with PD-L1 expression ≥50%.

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      EP1.16-20 - Pembrolizumab - Subsequent Lines in Non-Small Cell Lung Cancer: The Experience of a Tertiary Hospital (Now Available) (ID 2908)

      08:00 - 18:00  |  Author(s): Telma Costa

      • Abstract
      • Slides

      Background

      Pembrolizumab is currently approved for the treatment of metastatic NSCLC, with PD-L1 expression ≥1% and with progressive disease during or after treatment with chemotherapy.

      Method

      A retrospective study was conducted in patients with metastatic NSCLC with ≥ 1% of PD-L1 expression, proposed for subsequent therapeutic lines with pembrolizumab. Patients were recruited in our Thoracic Tumor Unit between June 2017 and December 2018. An epidemiology characterization of patients was performed and progression-free survival (PFS) was analyzed throw a Kaplan-Meier method.

      Result

      Fourteen patients were included. The majority of patients were male (85.7%), with a mean age of 65±11 years, and 78.6% of them were smokers or former smokers. The observed PS was: PS0 in 7.1% and PS1 in 92.9%. The most prevalent histologies were adenocarcinoma (71.4%) and squamous cell carcinoma (28.6%), with the majority of patients in stage IV (78.6%) at the time of initiation of pembrolizumab. The median of PD-L1 expression was 60% (IQR 50). Mutations and translocations (KRAS and BRAF) were present in 38.5% of these patients.

      Partial disease remission was achieved in 28.6% of patients, stable disease in 50.0%, and 21.4% of patients progressed. The median PFS was 8.0 months. Adverse effects were documented in 28.6% of patients, namely hypothyroidism (28.6%) and hepatitis (7.1%). Only one patient developed grade 3 adverse effect that led to drug interruption.

      Conclusion

      The PFS obtained in our study was twice as large as that described in the literature (3.9 months), although due to the small number of patients it was not possible to divide in subgroups of PD-L1 expression. However, the high median of PD-L1 expression in our study may explain in part the results obtained. The authors intend to show that pembrolizumab in 2nd line is an effective drug and should be considered in patients with high expression of PD-L1.

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