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Michael George Pavlakis



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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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      EP1.01-84 - Second Line Treatment with Docetaxel/Nintedanib in Patients with Metastatic Non Small Cell Lung Adenocarcinoma-Preliminary Results (Now Available) (ID 2302)

      08:00 - 18:00  |  Author(s): Michael George Pavlakis

      • Abstract
      • Slides

      Background

      The treatment landscape of non small cell lung cancer (NSCLC) has changed dramatically during the last years involving targeted therapy, chemotherapy ± immunotherapy or/and antiangiogenic agents, based mainly on patients’ molecular characteristics. Not all patients respond well to immunotherapy, so there is an essential need for other effective treatments.

      Method

      The aim of this prospective study is to estimate and record, the efficacy of the combination of Docetaxel with Nintedanib as a second line therapy in metastatic NSCLC. There were 20 patients, 16(80%) men, 4(20%) women, median age 62(52-73) years and median ECOG 1(0-3), without driver mutations, consecutively admitted in Evangelismos Oncology Department in Athens, Greece from 27/11/2017- 23/02/2019.

      Result

      All patients had received Cisplatin/Pemetrexed/Bevacizumab as first line treatment for their disease, with a median duration of 104(45-255) days. Progressive disease sites were found in lung, liver, and bones in :18/20(90%), 8/20(40%) and 4/20(20%) patients respectively. All received as second line treatment Docetaxel 75mg/m2 q3weeks plus Nintedanib 400mg p.o., d 2-20 in 21 days cycles. CEA, CA125, NSE, CA19.9, CA72-4 and Cyfra 21.1 tumor markers were monitored according to our clinical protocol. Increased values of these markers were documented at initiation of therapy in 18, 14, 10, 14 ,0, 2 patients respectively.

      After 3 cycles of treatment all patients were reevaluated and in 2 of them partial response (P.R.) was documented, with 40-50% reduction of CEA, CA125, CA19.9 και Cyfra 21.1, while 12 patients had stable disease (S.D.) with no more than 20% change in the aforementioned tumor markers. Six patients with progressive disease (P.D.) showed significant increase of CEA, CA 125, NSE, CA 19.9 and CA 72-4. The responders (P.R.+ S.D.) continued therapy for a median of 5(3-8) cycles.

      Among 96 cycles of chemotherapy, any toxicity grade ≥ ΙΙ occurred in 14 (7%) of them. Anaemia in 7(50%), stomatitis in 4(28.5%), diarrhea in 5(36%) and AST/ALT elevation of >2.5 fold in 3(21%) cycles respectively. All patients were treated symptomatically, without dose reduction in any patients

      Conclusion

      The combination of Docetaxel/Nintedanib in metastatic NSCLC adenocarcinoma, following progressive disease post Cisplatin/ Pemetrexed/ Bevacizumab treatment, showed 70% response rate. Although the number of the patients included in the study is small, we concluded that the tumor markers examined, had a clear correlation with the disease outcome. No major toxicity issues were documented. Larger studies are needed in order to make more solid conclusions.

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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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      EP1.04-13 - Immunotherapy Versus Chemotherapy for Previously Treated Metastatic NSCLC. Results from Daily Clinical Practice (ID 645)

      08:00 - 18:00  |  Presenting Author(s): Michael George Pavlakis

      • Abstract
      • Slides

      Background

      Immunotherapy has shown promising results in the treatment of mNSCLC.The aim of this retrospective analysis was to compare the efficacy and toxicity of chemotherapy and immunotherapy in the 2nd line treatment of mNSCLC.

      Method

      Fifty-nine patients with advanced NSCLC consecutively admitted in our Medical Oncology Department were enrolled in the study. A total of 83% were men, and 17% women. Patients had median ECOG 1 (0-3), median age 68 (47-86) years, squamous(32%) and non-squamous histology(68%). All of them were previously treated with 1st line chemotherapy regimens. Following disease progression, they received either chemotherapy or immunotherapy as 2nd line therapy .We compared both the efficacy and toxicity of the two therapeutic options. In the immunotherapy arm, patients received either Nivolumab, or Pembrolizumab.

      Result

      The number of patients whose disease progressed after receiving chemotherapy in the 2nd line, was similar to those who received immunotherapy. However, time to progression, was significantly shorter in the chemotherapy arm (p=0,015). There was significant difference in disease progression probability between the two arms in both 3 and 6 months (p<0,05).

      Patients with at least one adverse event had 2,27 times higher probability of disease progression. Median overall survival was 8 months for the chemotherapy arm in second line, compared to 14 months in the immunotherapy arm.graph2.jpg

      There was no difference in survival between the two arms in the 6 month evaluation (p>0,05). However, in the 12 and 18 month evaluation, survival rates were significantly higher for patients in the immunotherapy arm (p=0,006 και p=0,001 respectively).

      Conclusion

      Patients who received immunotherapy in 2nd line, had siginificantly higher overall survival rates, compared to those that received chemotherapy (p=0,006). There was no correlation between PD-L1 expression levels and clinical benefit. Immunotherapy had a better safety profile compared to chemotherapy. Data from our daily clinical practice are in line with current literature.

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    EP1.12 - Small Cell Lung Cancer/NET (ID 202)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.12-14 - Multiple Primary Malignant Neoplasms in Patients with Small Cell Lung Cancer. The Experience of Our Center (Now Available) (ID 715)

      08:00 - 18:00  |  Author(s): Michael George Pavlakis

      • Abstract
      • Slides

      Background

      Treatment and, mainly, modern diagnostic tools during the first diagnosis of the disease and follow-up, seem to improve survival in patients with small cell lung cancer (SCLC) and thus increase the number of patients diagnosed with multiple primary malignant neoplasms.

      Method

      The aim of this retrospective study was to estimate and report the incidence of multiple primary malignant neoplasms and discuss the clinical characteristics of this subgroup of patients with SCLC.

      The study includes all patients consecutively admitted between 1/1983 -3/2019 at the Department of Medical Oncology, Evangelismos General Hospital, Athens, Hellas.

      Result

      Five hundred fifty eight patients [386(69%) men, 172(31%) women, 285(51%) with limited and 273(49%) with extended disease] were included in the study. Median age was 63 (33-87)years, median ECOG was 2 (0-4) and median time of follow-up was 18+ (1+ - 696+) months. Three hundred ninety six (71%) had a short period of follow-up ≤24 months (group A), while 162 had a period of follow-up >24 months (group B). Multiple primary malignant neoplasms were detected in 23(4%) patients, 20(5%) men and 3 (2%) women (p<0.05), synchronous in 11(48%) and metachronous in 12(52%) patients, p=NS. The second malignant neoplasms were lung adenocarcinoma, squamous cell lung carcinoma, colon adenocarcinoma, bladder transitional cell carcinoma, head and neck squamous cell carcinoma, prostate adenocarcinoma, NHL, and thyroid follicular carcinoma in 7, 5, 4, 3, 2, 1 and 1 cases respectively. In the group of the 285 patients with limited disease 16(6%) multiple primary malignant neoplasms were observed in relation to 7/273(2.5%) of the patients with extensive disease (0.01< p<0.05). The multiple primary neoplasms were 12/396(3%) and 11/162(7%), p <0.05 in patients of the groups A and B respectively.

      Conclusion

      1. Development of multiple primary malignant carcinomas in patients with SCLC, does not seem to be a rare phenomenon. 2. The great majority of the multiple primary carcinomas (lung adenocarcinomas, squamous cell lung carcinomas, bladder transitional cell carcinomas, head / neck carcinomas) is smoking dependent. 3. The risk was higher in males, in patients with limited disease and in those surviving more than 24 months.

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    P2.01 - Advanced NSCLC (ID 159)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.01-61 - Multiple Primary Carcinomas (MPC) in Patients with Non Small Cell Lung Cancer (NSCLC) (ID 914)

      10:15 - 18:15  |  Author(s): Michael George Pavlakis

      • Abstract
      • Slides

      Background

      The improving survival of NSCLC patients, due to: 1. the initial diagnosis in early stages using the newer modern diagnostic tools, 2. the treatment of the disease with new effective antineoplastic drugs, and 3. the remarkable suspicion of the physicians, leads to registry of high incidence ratio of MPC in NSCLC patients.

      Method

      The aim of the study was the registration of the number and clinical characteristics of MPC in NSCLC patients. Between 4/1986-3/2019, 1756 patients, 1123 (64%)men, 633 (36%)women, median age 64(33-87)years and ECOG 2(0-3) were consequently admitted in our Unit. Stage <IIIA had 304(17%) and ≥IIIA 1452(83%)patients (groups A, B respectively). Median follow-up was 20+(1+-240+)months. Survival ≥5years observed in 351(20%)patients. According to our protocols, patients stage <IIIA, underwent only follow-up after radical surgery, while patients stage IIIA treated with platinum-based chemotherapy(PBC) adjuvantly or neoadjuvantly±locoregionally radiotherapy. Patients stage ≥IIIB received therapeutically PBC±radiotherapy.

      Result

      Eighty-six patients, 78/1123(7%)men, 8/633(1%)women (p<0.001), developed 102 MPC. The median interval time between NSCLC diagnosis and MPC detection, was 58(0-220)months. Two men experienced by four (all metachronous)MPC. One with lung adenocarcinoma(LADC), developed non-AIDS Kaposi-sarcoma of the leg, MDS and squamous-cell lung cancer(SqCLC). The second, with LADC, developed transitional-cell bladder carcinoma(TCBC), prostate adenocarcinoma(PrC), and colon cancer(CC). Five patients(3 men, 2 women) had by three, metachronous, MPC. One had LADC, NHL, CC, the second LADC, TCBC, PrC, and the third SqCLC, CLL and CC. One woman experienced LADC, lymphopenic HL and breast cancer(BC) and the other LADC, CLL, and small-cell lung carcinoma. Other 79 patients developed 79 MPC, 11(14%)median age 63(51-77)years, synchronous and 68(86%)median age 63.5(34-75)years, metachronous The synchronous were LADC/SqCLC in 2, LADC/PrC in 2, LADC/TCBC in 2, SqCLC/head-neck squamous-cell carcinoma(HNSqCC) in 2, and SqCLC/CC in 3 cases. The metachronous MPC were LADC, CLL, TCBC, SqCLC, PrC, CC, HNSqCC, BC, NHL, HL, in 12, 10, 8, 8, 8, 8, 6, 3, 3, 2, cases respectively. Among 351 patients surviving ≥5years, 40(11%) experienced MPC versus 46/1405(3%) with survival <5years(p <0.001). Seventy-five patients diagnosed with metachronous MPC: 10/304(3%) versus 65/1452(4.5%) of group A and B, (p=NS). There was no statistically significance in the location of non-haematological MPC related to the diaphragm (37 upper, 39 lower the diaphragm).

      Conclusion

      According to our findings in NSCLC patients: 1. MPC detection is not uncommon, mainly in men. 2. The longer survival enhances the possibility of MPC. This must be considered during the follow-up of those patients. 3. Previous chemoradiotherapy doesn’t increase the risk of MPC.

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