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Nagashree Seetharamu



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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: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.01-35 - Concurrent Use of Low Dose Aspirin and Vitamin D inĀ ALK, ROS and EGFR Mutant NSCLC: A Single Institution Retrospective Analysis (Now Available) (ID 2434)

      08:00 - 18:00  |  Author(s): Nagashree Seetharamu

      • Abstract
      • Slides

      Background

      Tyrosine kinase inhibitors (TKI) are the backbone therapy for EGFR, ALK and ROS positive (pos) non-small cell lung cancer (NSCLC). Pre-clinical data suggest that low vitamin D level facilitates the growth of mutant EGFR NSCLC through Vitamin D receptor (VDR). VDR is highly expressed in EGFR lung cancer cells, and its interaction with activated 1,25 vitamin D3 (1,25D3) promotes epithelial differentiation and apoptosis while inhibiting cellular proliferation and angiogenesis. Thus vitamin D3 supplementation may potentially add anti-cancer activity to conventional therapy in this population. On the other hand, murine models have shown that prolonged use of aspirin reduces the incidence of distant metastases. It is postulated that biosynthesis of prostaglandins generate a permissive intravascular metastatic niche, through platelet aggregation and endothelial activation.

      Recent meta-analysis published by Feng et al. analyzed seventeen studies and reported statistically significant reduction in risk of lung cancer by 8% when circulating 25-VD is at 10 nmol/L, this benefit was seen in both Caucasian and Asian population. To our knowledge, there have been no studies looking at influence of concurrent vitamin D or aspirin intake on outcomes in ALK, ROS and EGFR pos NSCLC treated with tyrosine kinase inhibitors. We performed a retrospective single institution analysis to study this association.

      Method

      Patients (pts) with ALK, ROS EGFR pos NSCLC treated with first line TKI from January 2014 to June 2017 were included. Information on concurrent use and doses of aspirin and vitamin D supplements were studied. Patients were dichotomized based on use of these individual supportive medications. Two sample t-test was used to compare mean PFS and chi-square test to compare proportions of disease control rate (DCR) at 3 months between groups.

      Result

      74 patients were included. PFS in Vitamin D supplementation (n=41, 55%) group was 11 months compared to 10.2 m in those not on Vitamin D (p = 0.21, CI 1.9). For those on aspirin (n=23, 35%), mean PFS was 16m vs 12.5 m (p = 0.7213; 95% CI -5.5812 to 3.8812). DCR for aspirin use was 50% vs 65% (p = 0.1796) and for vitamin D 48.6% vs 43.7% (p= 0.6989).

      Conclusion

      Our study did not show any differences in PFS or DCR in EGFR, ROS and ALK positive NSCLC patients who were concurrently taking vitamin D or aspirin compared with those who were not. Our study was small and was not powered to pick up any significant differences. Given the strong pre-clinical background, further prospective studies would be interesting to evaluate the synergistic benefit of vitamin D and aspirin with concurrent TKI use.

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    P2.04 - Immuno-oncology (ID 167)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Immuno-oncology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.04-80 - Pretreatment Nutritional Status and Response to Checkpoint Inhibitors in Lung Cancer (ID 1272)

      10:15 - 18:15  |  Presenting Author(s): Nagashree Seetharamu

      • Abstract

      Background

      Immunotherapy has developed as an integral part of the treatment for lung cancer. Obesity has become a pandemic accounting for >20% of the total United States healthcare expenditure. Obesity has been shown to be associated with an increased efficacy of PD-1/PD-L1 blockade. On the other hand, cachectic patients have been shown to not respond as well to immunotherapy. In this study, we aim to assess the pretreatment nutritional status with outcomes of lung cancer patients being treated with immunotherapy.

      Method

      An IRB approved retrospective review of lung cancer patients receiving immunotherapy between 2014 and 2017 at the Monter Cancer Center, Northwell Health was conducted. Low nutritional status as defined by either a Body Mass Index (BMI) < 18.5 and/or albumin <3.5 mg/dL prior to immunotherapy treatment. Patients were stratified by BMI: underweight (BMI<18.5), normal weight (BMI of 18.5 to <25), overweight (BMI 25 to 30) and obese (BMI >30). The groups were compared using the log-rank test. Kaplan-Meier was used for overall survival (OS) and progression free survival (PFS) and Cox regression models were used to adjust for potential confounders.

      Result

      A total of 116 were included in the analysis, with a median age of 70 (95% CI, 62.5 to 75.5). Patients with a low nutritional status had a median PFS of 2.2 months compared to those who did not of 5.2 months (p<0.00032). Ten (8.6%) were underweight, 44 (37.9%) were normal weight, 32 (27.6%) were overweight, and 30 (25.9%) were obese. PFS was 6.6, 6.0, and 6.9 months for patients in the underweight, normal weight, and overweight/obese groups, respectively. A total of 46 (40%) deceased within the follow up period: 3 (30%), 17 (39%), 11 (34%), and 15 (50%) respectively. BMI classification were not found to be a significant predictor of survival, after adjusting for therapy duration (p=0.44).

      Conclusion

      In this single institution retrospective review, lung cancer patients receiving immunotherapy with our defined low nutritional status had a lower PFS. BMI or albumin as individual factors did not have a significant effect on PFS or OS. Additional studies are needed to validate these findings and assess the effects of nutritional status on immunotherapy.

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    P2.11 - Screening and Early Detection (ID 178)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.11-03 - Implementing Physician Education to Increase Lung Cancer Screening Compliance (Now Available) (ID 611)

      10:15 - 18:15  |  Author(s): Nagashree Seetharamu

      • Abstract
      • Slides

      Background

      Lung cancer is the leading cause of cancer-related deaths worldwide. The USPSTF recommends annual low-dose CT chest (LDCT) for lung cancer screening in adults who meet the appropriate criteria: age 55-80, current smokers or former smokers who quit within 15years, with a 30 pack-year smoking history. Even with these recommendations, screening rates in these patients remain low. We created a study to assess compliance in an outpatient Internal Medicine clinic to assess the barriers for obtaining LDCT. We hypothesized that by providing an educational program, overall compliance would increase.

      Method

      The study was divided in two arms: a pre-intervention arm and a post-intervention assessment. Initially, 35 physicians completed a questionnaire on their attitudes to LDCT screening and their reasons for not screening high risk patients. We created a lung cancer screening education program, which consisted of lectures provided to physicians. Following the lectures, consecutive patient visits were reviewed to assess compliance with screening.

      Result

      In the first arm, 678 visits were reviewed. 115 patients met USPSTF criteria of whom 26% underwent screening. 29/546 (5%) underwent LDCT without meeting criteria. The most common reasons for not ordering LDCT scans in patients meeting criteria included: poor knowledge of criteria (22%), failure to determine if patients qualified (13%), and patient refusal (8%). Following the education, 208/955 patients reviewed met USPSTF criteria, of which 78% underwent LDCT and 27/738 (3.6%) who did not meet criteria were screened for lung cancer. Our study showed that after education, physicians were ten times more likely to screen patients for lung cancer (Odds ratio 9.98, 95% CI 5.87-16.94, p<0.0001).

      Conclusion

      We confirmed there was a suboptimal adherence to established LDCT lung cancer screening guidelines, mainly due to unfamiliarity with the screening criteria. By providing educational lectures, compliance improved significantly. We concluded that educating physicians about lung cancer screening guidelines can effectively increase LDCT screening tenfold, and therefore benefit patients at high risk for developing lung cancer.

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