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Aarati Shah



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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
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.01-30 - Clinico-Pathological Profile of Adenocarcinoma of the Lung – A Prospective Study in a Nepalese Population (Now Available) (ID 722)

      08:00 - 18:00  |  Author(s): Aarati Shah

      • Abstract
      • Slides

      Background

      Lung cancer represents the most common cause of cancer related mortality in developing countries including Nepal where patients (pts) often present in advanced stage. The purpose of this study was to determine the incidence and clinico-pathological profile of pts with adenocarcinoma of the lung (ACL) presented to a tertiary care center of Nepal.

      Method

      An IRB approved prospective study was conducted in pts with ACL over a period of 15 months from April 2017 to July 2018 at a tertiary care center, Bir Hospital, Kathmandu. Demographic data, history of smoking, histological type, presence and type of epidermal growth factor receptor (EGFR) mutations were studied. EGFR-analysis was performed using TheraScreen EGFR mutation kit.

      Result

      A total of 253 pts were diagnosed with lung cancer in the period. Of the 83 (33%) diagnosed with ACL, 45 (54%) were males and 38 (46%) females. The mean age at diagnosis was 59.4 years, and 74 (89%) were in stage III/IV. Forty eight (58%) pts were smoker of whom 30 (63%) pts had less than 10 pack years. Sixty one percent (61%) were illiterate. Eighteen (22%) pts had wrongly received anti-tuberculosis treatment before the diagnosis of ACL was made. All ACL pts were tested for EGFR-mutations which were found in 24 (29%) pts, the most common mutation being exon 21 (L858R) (42%) followed by exon 19 deletion (38%). Exon 18 and exon 20 (T790M) mutation were found in 2 pts (8%) each. One pt had dual mutation in exon 20 (T790M) and exon 21 (L858R).

      Conclusion

      The frequency of EGFR-mutations in ACL in this Nepalese cohort was lower than in Eastern Asian studies, but higher than in western population. EGFR mutation testing of ACL has to be encouraged in developing countries like Nepal as presence of these mutations predict durable response to oral tyrosine kinase inhibitors. Interestingly, lung cancer is often mistreated as tuberculosis leading to delay in diagnosis and treatment.

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      EP1.01-40 - Outcome of EGFR-Mutated and Non-Mutated Lung Adenocarcinoma Receiving Standard Therapy - A Nepalese Cohort (Now Available) (ID 941)

      08:00 - 18:00  |  Author(s): Aarati Shah

      • Abstract
      • Slides

      Background

      Lung cancer represents major health challenges worldwide including Nepal where patients (pts) often present in advanced stage. The purpose of this study was to compare the objective response rates (ORR), progression free survival (PFS), and quality of life (QoL) of EGFR-mutated (EGFR-mut) and non-mutated (EGFR-wt) pts with adenocarcinoma of the lung (ACL) receiving standard therapy.

      Method

      An IRB approved comparative analytical study was performed in pts with ACL. Newly diagnosed stage IV ACL pts were enrolled and ORR, PFS and QoL was compared between EGFR-mut and EGFR-wt (33 pts in each arm) pts. EGFR-mut pts were given gefitinib and EGFR-wt pts were given systemic chemotherapy (pemetrexed/cisplatin or cisplatin/etoposide). Response evaluation was done using RECIST criteria in both arms. PFS was calculated from the date of starting treatment to the date of progression and QoL was evaluated using EORTC QLQ-C30 (version 3) questionnaire and compared between two arms. Adverse effects were assessed using CTCAE criteria. Pts were followed for 1 year.

      Result

      Complete response (CR) was achieved in 9.1% vs 3.0 % (p=0.46), and ORR was 27.3% vs 15.2% (p=0.23) in EGFR-mut vs EGFR-wt. The median PFS was 11 and 9 months for EGFR-mut and EGFR-wt respectively (p = 0.045). The mean score of global health status from EORTC QLQ-C30 was 68.1 vs 61.6 in EGFR-mut pts vs EGFR-wt pts (p = 0.036). Skin toxicities were more common in pts receiving gefitinib. One pt had grade 3 skin toxicity. Febrile neutropenia and peripheral neuropathy (either grade 1 or grade 2) were the most common toxicities in pts receiving standard chemotherapy.

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      Conclusion

      EGFR-mut pts treated with EGFR-TKI had improved ORR, PFS and QoL in comparison with EGFR-wt pts treated with chemotherapy. EGFR-mutational analysis and EGFR-directed therapy is feasible and provides survival benefit, also in developing countries as Nepal.

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    P1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 186)

    • 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: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.16-19 - Understanding Physician Barriers in the Management of Lung Cancer in Nepal. Can Educational Intervention Make a Difference? (Now Available) (ID 776)

      09:45 - 18:00  |  Author(s): Aarati Shah

      • Abstract
      • Slides

      Background

      Lung cancer is the leading cause of cancer morbidity and mortality for both men and women in Nepal. A majority of patients present with advanced or metastatic disease and some patients are never referred to an oncologist for further treatment after diagnosis. Many factors contribute to this, but diagnostic delay, lack of prompt referral and nihilistic attitude towards lung cancer seem to be most important. Potentially, a lack of oncology training and exposure contributes to this. Herein, we evaluated the physician related factors contributing to the current scenario of lung cancer treatment in Nepal and whether oncology education could make a difference.

      Method

      A prospective pilot survey among residents and faculty from 10 medical colleges with Internal Medicine programs across Nepal was performed. A structured, self-administered questionnaire focusing on physician’s behavior, practice, and attitude towards lung cancer was used. The questionnaire was distributed by e-mail to each site and a printed copy given to participants.

      Result

      74 participants responded to the survey questionnaire. Only 3 out of 10 Internal Medicine programs had a compulsory oncology rotation in their residency program. Multiple factors contributed to delay in diagnosis of lung cancer. 66 participants (91.6%) responded that they gave empirical anti-tubercular drugs(ATT) to patients with a non-resolving consolidative mass before they began evaluation for lung cancer; 22 % deferred CT scan before ATT. Multiple courses of antibiotics was a common practice in 62.5% participants. Misattribution of existing symptoms was common. 83.3% agreed that they treated smokers with respiratory symptoms initially as COPD with no consideration of lung cancer while 72.2% did not consider lung carcinoma in a middle-aged, never-smoker female with non-resolving consolidative mass. A paired t-test was used to analyze the responses among participants with oncology education during their residency with those who did not have an oncology rotation and was statistically significant (p= 0.001). We also discovered that 36.1% of participants don’t refer elderly patients with lung cancer to an oncologist because they think lung cancer treatment is usually futile, toxic and does not help the patient.

      Conclusion

      Lung cancer remains a neglected disease in Nepal. There is an urgent need to overcome physician related barriers by oncology education for physicians and in training programs for early diagnosis and treatment of lung cancer for potential improvement in survival and quality of life in patients with lung cancers.

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