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Laura Angelats



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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
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.01-37 - Platinum-Based Chemotherapy (CT) Rechallenge in Advanced Non Small Cell Lung Cancer (NSCLC) Patients (p): A Single Institution Experience (ID 2689)

      08:00 - 18:00  |  Author(s): Laura Angelats

      • Abstract
      • Slides

      Background

      No phase III trials have been carried out to prove the value of a platinum-doublet rechallenge in p with NSCLC. Currently, the availability of different effective drugs makes the platinum-based salvage therapy unusual. Moreover, the potential cumulative toxicity related to cisplatin or carboplatin can be an issue. However, retreatment with platinum-based CT could be hypothetically proposed for p with a long time to progression (TTP) from the last platinum treatment, in p with a good performance status, who may be symptomatic and with no formal contraindication to receive such treatment We have retrospectively reviewed experience at our institution of platinum-based chemotherapy rechallenge in stage III and IV NSCLC p

      Method

      A cohort of 376 p with stage III and IV NSCLC treated with first-line platinum doublets from January 2012 to December 2017 were included. We extracted information on clinical and molecular characteristics, as well as treatment details. Time to progression was evaluated by Kaplan-Meier curves and groups were compared using Log-rank test.

      Result

      Overall, 57 p were rechallenged with platinum-based CT (group A). Median age was 57 years (51.5-65) for rechallenged p versus (vs) 62 (56.2-68.8) for the entire cohort (group B)[p=0.001]. Group A include more p with stage III p( 54.4% vs. 30.7%; p=0.001), as well as more p with better ECOG Performance Status (PS) (PS 0 70.2% vs. 44.5%; p=0.001). No differences in gender, smoking status, histology and comorbidities were observed between both groups (20.7% and 29.8% were women and 38.6% and 53.9% were smokers in groups A and B, respectively).

      No differences in molecular profile (EGFR, ALK, ROS1, KRAS, BRAF) were observed. The most common platinum doublet administered in first line setting was cisplatin plus pemetrexed. Group A received more frequently carboplatin plus gemcitabine or vinorelbine. Disease Control Rate (DCR) was 57.9% in p included in group A. No differences in DCR were observed in first line between both groups. Time to progression or death was 9.6 m for gropuo B(5-18.1) vs 20.5 m (14.6-37.3) p <0,001 for p in group A.

      Conclusion

      Rechallenge with platinum-based CT doublets could represent an option for NSCLC p with good PS and no contraindications for such therapy.

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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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      EP1.04-25 - Increased PD-L1 Expression in MET Amplified (AMP) Advanced Non Small Cell Lung Cancer (NSCLC) Patients (P) (ID 2764)

      08:00 - 18:00  |  Author(s): Laura Angelats

      • Abstract
      • Slides

      Background

      MET amp has been reported in a subset of NSCLC p and treatment with crizotinib has proved clinical activity in cases of MET exon 14 alterations and MET amp.. Recently, immunotherapy has emerged as a new approach to treat NSCLC. The development and success of programmed cell death 1 (PD-1)/program death-ligand 1 (PD-L1) checkpoint inhibitors has been correlated with PD-L1 status, particularly in NSCLC p whose tumors express high PD-L1 levels by tumor proportion score (TPS) ⩾ 50%. In this study we have reviewed the PD-L1 status in a cohort of advanced NSCLC p with a METamp.

      Method

      PDL1 expression has been evaluated in a retrospective cohort of NSCLC p with MET amp and wild type for EGFR, KRAS, BRAF mutations and ALK and ROS1 rearrangements. Overall Survival (OS) was evaluated with Kaplan-Meier curves and groups were compared using log-rank test. Clinical and tumor characteristics, as well as treatment details, were evaluated. MET amp was analyzed by FISH, while PD-L1 status was assessed by immunochemistry by SP 263. antiboby

      Result

      A total of 50 p were included, 15 p has high or intermediate Met amp and 35 p had low or negative Met amp. Median age were 66 years old. 39 (78%) p were male, 43 (86%) p were smokers or former smokers, 37 p (74%) were ECOG PS 0-1, 37 p (74%) were stage IV. PD-L1 were negative ( < 1%) in 21 p (42%), positive ( >1%) in 26 p ( 52%). PD-L1 highly positive in 18 p ( 36%). Statistically significant more p had PD-L1 positive ( TPS > 1%) in high or intermediate Met amp p versus low or negative ( 92.9% vs 39.4%; p 0.001). And high or intermediate Met amp p had PD-L1 high expression ( TPS > 50%) than negative or low Met amp p ( 64.3% vs 27.3%; p 0.020). No differences in PD-L1 expression was observed by gender, ECOG PS or smoking status. Median OS was 16.367 m (2.295-30.438). No differences in OS were seen by PD-L1 expression or Met amp status.

      Conclusion

      PD-L1 expression in NSCLC p is positively correlated with MET amp, especially in p with PD-L1 > 50%. Our data suggests that MET amp may play a direct role in up-regulating PD-L1 expression in NSCLC p. Additionally, combination therapy targeting MET and checkpoint inhibition should be considered as a potential therapeutic strategy for NSCLC p with high and intemediate MET amp.

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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: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.16-17 - Management of Inappropriate Use of Opioids (IUO) in Patients (P) with Lung Cancer (LC) (Now Available) (ID 612)

      08:00 - 18:00  |  Author(s): Laura Angelats

      • Abstract
      • Slides

      Background

      Pain represents one of the main symptoms in patients (p) with lung cancer (LC). Currently, the molecular classification and targeted therapies and immunotherapy for LCp yield a prolonged survival in some p. In this context, analgesia with opioid therapy (OT) requires special caution. The prevalence of IUO LCp is unknown and its assessment is suboptimal. There is no current recommendation to assess IUO risk in cancer p, other than in long cancer survivors with chronic pain. Several scales are validated for the screening of aberrant OT-behaviors. The Addiction Unit (AU) role could be key in the evaluation and minimization of the IUO risk (Fig.1)

      STUDY DESIGN:Prospective study for the evaluation of IUO risk in LCp. P with intermediate/high risk of IUO will be referred to the AU for evaluation and follow-up (Fig.1)

      OBJECTIVES:Determine if screening scales are capable of detecting the risk of IUO in LCp. Reduce the impact of IUO in LCp by assessment and follow-up in the AU.

      VARIABLES: Main: To determine if the Cut down-Annoyed-Guilty-Eye opener (CAGE-AD) and Opioid Risk Tool (ORT) scales are able of detecting the risk of IUO in LCp. Secondary: Determine if the urine and blood drug testing (DT) reinforces the information of such scales. Determine the risk reduction of IUO after the intervention of the AU.

      Method

      ELIGIBILITY CRITERIA (Fig.1)

      SCALES:The MO team will use the following scales for the IUO risk assessment: CAGE-AID, ORT. Visual Analogic Scale (VAS) and Edmonton Symptom Assessment Scale (ESAS) will be used for pain evaluation. LABORATORY: DT (urine/ blood ethanol)

      ASSESSMENT OF IUO RISK: Proposed timeline and strategies at the AU are summarized in Fig.1.

      SAMPLE SIZE:Study will include 45 p in a 1-year period.

      Approved by IRB-Hospital Germans Trias in Pujol, Nov, 23th2018 (UIO-pulmon 2018)

      picture1.png

      Result

      Section not applicable

      Conclusion

      Section not applicable

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    P1.01 - Advanced NSCLC (ID 158)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.01-93 - Metastases Sites as a Prognostic Factor in a Real-World Multicenter Cohort Study of Spanish ALK-Positive NSCLC Patients (p) (ID 1377)

      09:45 - 18:00  |  Presenting Author(s): Laura Angelats

      • Abstract

      Background

      ALK gene rearrangements are detected in 3-7% of Non-Small-Cell-Lung-Cancer (NSCLC) p. EML4-ALK translocation was first identified as an oncogene in NSCLC p in 2007. To date, published real-world data on the prognostic factors of patients with ALK-positive advanced NSCLC in Spain are limited. We aim to evaluate the effect of number of metastases (M1) organs on overall survival (OS) in a multicenter cohort of Spanish ALK-positive NSCLC p diagnosed between 2008 and 2017.

      Method

      We included p with stage IV at diagnosis since 2011 to April 2018. OS (months [m]) was estimated with the Kaplan-Meier method. Survival curves were compared between groups of p using the log-rank test. Hazard risk (HR) to death was estimated with multivariable Cox model, adjusted by site of metastases, gender, age and first line type of treatment.

      Result

      Out of the 163 p in the cohort a total of 98 p were included, with a median follow-up of 28.6 m and 45 deaths reported. Characteristics at diagnosis were median age 58 years, female 46.9%, never-smokers 59.2%, 50% with comorbidities, PS by ECOG 0-1 93%, 58.2% lung M1, 45.9% central nervous system M1, 42.9% bone M1, 22.4% liver M1 and 29.6% pleural M1.

      54.3% p and 89.4% p were treated with ALK inhibitors as first line and second line respectively. The median OS was 34.4 months, being 46.9 months in p treated with ALK inhibitors and 38.8 months in p treated with chemotherapy as first line (p= 0.9).

      There were 72 p who presented M1 in more than one organ and 26 p in a single organ. The risk of death increased with greater number of organs involved at diagnosis (HR= 3.0, p=.016), and presenting liver M1 at diagnosis (HR=2.2, p=.046, with OS of 19.1 m), compared to p single site involvement (OS: 45.4 m).

      Conclusion

      OS was worse with increased metastatic sites involved at diagnosis in p with ALK positive NSCLC, being liver M1 associated with the highest risk of mortality. Brain metastases at diagnosis were not a prognostic factor for OS in our series.

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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
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.16-44 - Multiple Primary Cancers (MPC) in a Cohort of Lung Cancer (LC) Patients (P): Incidence and Clinical Features (ID 2236)

      09:45 - 18:00  |  Author(s): Laura Angelats

      • Abstract

      Background

      The prognosis of p with LC has drastically changed during the last decade due to the improvement in prevention, diagnosis and treatment. Therefore, the number of LC survivor ps has significantly increased and subsequently the incidence of MPC is also rising. This study investigates the co-occurrence of MPC among p diagnosed with LC.

      Method

      We reviewed of clinical data of patients with histologically confirmed LC visited at our institution between February 2016 and December 2018.

      Result

      A total of 492 p out of 777 p, (63.3%) had adenocarcinoma and 223 p (28.7%) had squamous LC. The most frequently related comorbidities were hypertension (42.5%), dyslipidemia (36.2%), COPD (21%), cardiovascular disease (15.7%) and diabetes mellitus (14.5%). Molecular analysis was perform in 402 p (51.7%). EGFR mutation was detected in 77 p (exon 19 in 14% and exon 21 in 5% of p). ALK and ROS1 translocation were diagnosed in 27 and 7 p, respectively.

      Two primary cancers occurred in 111 cases (14%), including 15 p (1.9%) with three or more primary cancers. Patients with MPC were predominantly males (76.8%), smokers (85%) and 34% had prior family history of MPC. Median age at the first tumor diagnosis was 64 years (57-71). LC occurred as first neoplasm in 8.1% of the cases, 92 p (83%) developed metachronic MPC and 19 p (17%) synchronous MPC. Most common secondary primary cancer were head and neck in 19%, non-melanoma skin cancer in 19%, prostate in 12.6%, bladder and upper urinary tract cancer in 10%, colorectal in 6.3% and breast in 5.4%.

      First-line treatment for advanced or locally advance LC included chemotherapy in 65.6%, concomitant chemoradiotherapy in 14%, targeted therapy in 4% and immunotherapy in 4%. Overall response rate (ORR) to first-line treatment was 43.7%. Second-line treatment included chemotherapy in 47.6% and immunotherapy in 30.4%, with and ORR of 30%.

      Conclusion

      In our series, the frequency of the co-occurrence of MPC among LC p is 14%, suggesting that surveillance strategies are recommended in this population. Most frequent MPC in LC patients are related to smoking. ORR in first and second-line are consistent with the literature.