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Rita Gomes



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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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      EP1.01-87 - Cutaneous Metastasis in Lung Cancer – A Retrospective Study in a Local Health Unit in Guarda, Portugal (Now Available) (ID 2841)

      08:00 - 18:00  |  Author(s): Rita Gomes

      • Abstract
      • Slides

      Background

      Cutaneous metastasis from lung cancer is rare, occurring in 0.22-12% of cases. Their presence has generally been considered a sign of an already disseminated, poor-prognosis and non-surgical disease. Current data suggest lung cancer is the second most frequent cause of cutaneous metastasis in men, behind malignant melanoma.

      Method

      We conducted a retrospective analysis of patients diagnosed with lung cancer and cutaneous metastasis, submitted to skin biopsy to confirmation, from November 2010 to March 2019, in our local health unit. Data regarding demographic characteristics, smoking history; location and histology and of the primary tumor; staging; number, location and type of skin lesion; overall survival and survival after detection of cutaneous metastasis were collected from clinical records.

      Result

      Five patients were included, 4 were of male gender (80.0%), with median age of 79 years (range, 56-88). Three patients (60.0%) were former smokers, 1 current smoker and 1 non-smoker. The location of the primary tumor was right upper lobe (3 cases, 60.0%) and left lower lobe (2 cases, 40.0%); histology of adenocarcinoma in 3 patients (60.0%), 1 patient with squamous cell carcinoma and another with neuroendocrine carcinoma. All cases of lung cancer were diagnosed with an initial stage IV disease. Most of them had a unique skin lesion, mainly a nodule, located either in the upper abdominal wall or dorsal region. From the 5 cases, 4 had died, with a median overall survival 0.5 months (range, 0-1) and survival after cutaneous metastasis 15.5 days (range, 12-82).

      Conclusion

      According to data, also in our study men had more cutaneous metastasis from lung cancer than women. Previous or active smoking history was present in almost all patients, the main histology type was adenocarcinoma and primary lung cancer was frequently located in right upper lobe, consistent with reported data. In all cases, lung cancer was diagnosed in an advanced stage and survival after diagnosis of cutaneous metastasis was extremely low.

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    EP1.14 - Targeted Therapy (ID 204)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Targeted Therapy
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.14-30 - Cerebrospinal Fluid for Liquid Biopsy in Leptomeningeal Metastases of EGFR-Mutant Non-Small-Cell Lung Cancer – A Case Report (Now Available) (ID 2830)

      08:00 - 18:00  |  Author(s): Rita Gomes

      • Abstract
      • Slides

      Background

      Leptomeningeal metastases (LM) occur in 3-4% of non-small-cell lung cancer patients, especially in 9.4% of those with an epidermal growth factor receptor (EGFR) mutation. EGFR tyrosine kinase inhibitors (TKIs) markedly prolong survival, but LM remain a devastating complication. Since leptomeningeal lesions are difficult to access, resulting in a poor understanding of the resistance mechanisms of LM, greater efforts have been made to trace the evolution of the tumor genome in accessible body fluids including plasma and cerebrospinal fluid (CSF).

      Method

      "Section not applicable"

      Result

      Case report: The presented clinical case refers to a 69-years-old female, PS 0, with a new right lower lobe nodule submitted to wedge resection surgery. Pleomorphic adenocarcinoma, staging IIB (pT3N0M0), and adjuvant chemotherapy with carboplatin and vinorelbine was done (4 cycles). Eight months after surgery, CT and PET-CT showed relapse with local and distant metastasis, staging IV (rT3N3M1b), EGFR mutation positive, initiating second-line therapy with erlotinib during 31 months, with complete response. By that time she initiated neurologic symptoms with headache and dysarthria. Head CT and MRI didn’t revealed any lesions, and there was no evidence of relapse in thoracoabdominal CT. A lumbar puncture (LP) was performed and CSF was sent to cytology (negative for neoplastic cells). Liquid biopsy with CSF and peripheral blood to search for the T790M mutation were both negative. Multidisciplinary decision was to maintain erlotinib, and was oriented to consultation of psychiatry and neurology. Three months later she had another predominant neurologic episode of disorientation, aggression and aggravated dysarthria. Head CT showed progression with multiple foci of leptomeningeal uptake in both cerebral hemispheres, confirmed by MRI. A new LP was performed and infectious etiologies were excluded; cytology was negative and repeated liquid biopsy of CSF and blood were negative for the T790M mutation. Erlotinib dose was increased to 600mg. Ten days after discharge, she returned with diffuse diarrhea and uncontrollable vomiting ending up dying a day later.

      Conclusion

      This case highlights the worse prognosis when LM exists and a high correlation between the onset or worsening of neurological symptoms and the development or progression of LM, before imaging; the use of CSF for liquid biopsy to search for T790M mutation, more than one time by the possibility of spatiotemportal heterogeneity; and also is in agreement with the existing literature that the EGFR T790M occurrence in CSF is relatively rare, potentially explained by the low exposure level of first-generation EGFR TKIs in CSF.

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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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      EP1.16-32 - Percentage of ALK Rearrangement as a Response Predictor in Non-Small Cell Lung Cancer Treatment (Now Available) (ID 2840)

      08:00 - 18:00  |  Author(s): Rita Gomes

      • Abstract
      • Slides

      Background

      The presence of the Anaplastic Lymphoma Kinase (ALK) fusion oncogene defines a subgroup of non-small cell lung cancer (NSCLC) with clinical and pathological characteristics. It is estimated that 4 to 7% of patients have this rearrangement and it may be detected in the tumour using fluorescence in situ hybridisation (FISH), immunohistochemistry (IHC), and reverse transcription polymerase chain reaction of cDNA. As we walk to a more personalised treatment in NSCLC, we need to search every day for more predictors of response to our newer therapies, such as ALK inhibitors.

      Our study aimed to correlate the percentage of ALK rearrangement found as a predictor of response in NSCLC ALK-positive treatment.

      Method

      Designed a retrospective study with NSCLC ALK rearrangement patients in a peripheral Hospital from the last six years. Collected demographic data, histology, disease stage, the percentage of ALK rearrangement detected by FISH, lines of treatment, the response rate (RR) evaluated by RECIST 1.1 criteria, the progression-free survival (PFS) and the overall survival (OS) in patients under ALK inhibitors. Results are presented as medians and range for non-normally distributed continuous variables and as number/total for categorical data. Statistical analysis was performed using U-Mann-Whitney test, considering a significance level of 5%.

      Result

      Eight patients diagnosed with NSCLC ALK-positive, male (4/8), aged 64 (28-85) years, most common histology pattern was adenocarcinoma (6/8), followed by adenosquamous (2/8), mainly in stage IV (6/8) and 2 in stage IIIB, where the most frequent distant metastasis was pleural (4/6), followed by bone (2/6) and pulmonary (1/6), none of the patients had brain metastasis. All ALK-positive with % of rearrangement 68 (18-100), PD-L1 positive, but under 50%, in 1/8 patients with no other mutation found. First line therapy was mainly platinum-based chemotherapy (6/8), followed by ALK inhibitor Crizotinib (2/8). As second-line therapy, all used ALK inhibitors, mainly Crizotinib (5/7) and then Ceritinib (2/7). In third line therapy, there was only one patient with Ceritinib. RR of the patients to the first line therapy was progression disease (5/8), partial response (2/8) and stable disease (1/8). RR in the second line therapy was progression disease (4/6), stable disease (1/6) and partial response (1/6). RR in the third line was progression disease. PFS was 5,5 (2-31) months, and when we used ALK inhibitors as first line, the PFS improved to 19 months. OS was 17 (5-53) months, and with ALK inhibitors as first line was 25 months.

      We found that there is no statistical correlation between the percentage of ALK rearrangement and the PFS, OS or the response rate in our patients, whatever the line of therapy. Nevertheless, there is an improvement in RR, PFS and consequently in OS among patients with ALK inhibitors in first line.

      Conclusion

      Besides our negative results with the the percentage of ALK rearrangement, we found in our sample an improvement in the RR, PFS and OS in patients that made in first line, ALK inhibitors rather than platinum-based chemotherapy, which is compatible with the literature and the use of ALK inhibitors in first line in NSCLC ALK-positive patients.

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