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Juan Jesús Valdéz-Andrade
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EP1.11 - Screening and Early Detection (ID 201)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.11-22 - Incorporating Genetic Counseling into the Thoracic Oncology Unit: A Pilot Project in the Real World (Now Available) (ID 2758)
08:00 - 18:00 | Author(s): Juan Jesús Valdéz-Andrade
- Abstract
Background
Lung Cancer (LC) is the 6th cause of cancer death in Mexican population. Genetic counseling (GC) in LC is not often offered in the Oncology departments in Mexico. CG is a process including education, genetic cancer risk evaluation, guidance about Genetic Testing (GT), and psychosocial support. Germline mutations in ATM, TP53, BRCA2, EGFR, and PARK2 cause a small percentage of LC; those patients (pts) could have benefits such as identify the genetic etiology, adjust surveillance, direct therapy, calculate transmission risk and even struggle with stigma. There are no clear criteria to refer LC pts to CG/GT. We started a GC service to identify which pts would benefit of GT. Herein, we describe our pilot project
Method
We reviewed medical records (MR) and offered GC to the new LC pts from sept2018-feb2019. The main objectives were: identify patterns of hereditary cancer syndromes, and analyse pedigrees of pts carrying the EGFR T790M mutation prior to treatment. We collected clinical, familial and demographic variables through the CG session. We reviewed the liquid biopsy results for EGFR, ALK and ROS. CG also included supportive measures and recommendations for GT according to the personal and family history (FH). No germline testing was available.
Result
79 cases were reviewed (66 MR and 13 CG sessions) Mean age was 61.54y (range 26-88). 45(57%) were females. 57% (45) were smokers. 40(50.6%) had positive FH. 8 had at least 1 member with LC, notably 1 had 3 relatives with LC. 21(26.58%) had at least 2 relatives with Cancer. Two pts had 7 and 10 relatives with CA. EGFR was mutated in 16 (20.25%), but T790M prior to therapy was found on 2 pts; they had no FH of LC. 3 tested positive for ALK, none tested positive for ROS. Pts with FH tended to be younger (p=0.046). 10 (12.65%) pts meet criteria for GT according to FH for breast, ovarian, prostate and colon cancer; 1 of those relatives tested negative for BRCA1&2 for Ovarian CA.
Conclusion
We think that implementing this service could increase the awareness of the potential use of GC in LC. Our sample is small, nonetheless we could identify at least 10 pts who would benefit of GT: multigene testing would be needed at least for these pts. Recognise the cases with hereditary background could bring many advantages to pts and their families. We expect to offer GT to LC pts and eventually, measure the potential advantages against stigma.
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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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P1.01-07 - Real World Data of Docetaxel Plus Nintedanib for Pretreated NSCLC Patients: 4 Yrs Update Compassionate Use Program Single Institution in Mexico (ID 2109)
09:45 - 18:00 | Author(s): Juan Jesús Valdéz-Andrade
- Abstract
Background
Nintedanib is an oral, potent, tyrosine kinase inhibitor that simultaneously targets vascular endothelial growth factor receptors 1-3, platelet-derived growth factor receptors α and β, and fibroblast growth factor receptors 1-3, as well as FLT3 and Src. Currently, the molecule has proved benefit for second-line in non-small cell lung cancer patients. Previous we report the results of a cohort of NSCLC patients receiving nintedanib within a compassionate-use program (CUP) in México demonstrated significant improvement in progression-free survival.
Method
Patients with advanced NSCLC progressing after one line of chemotherapy were enrolled. Eligible patients received docetaxel 75 mg/m(2) (day 1) plus nintedanib 200 mg twice daily; days 2-21) in 21-day cycles. Data collection was monitored. Treatment continued until disease progression or unacceptable drug-related AEs. The intention of this CUP was to provide controlled access to nintedanib. Here, we report a 4-year update, representing the longest follow-up of a real world study evaluating nintedanib docetaxel in combination therapy.
Result
From February 2014 to April 2015, 24 patients (54.2% female 45.8% male; median age: 61 years [range: 29-83 years]) were enrolled. ECOG performance status 0-1 in 100% of patients. Patients received nintedanib 200 mg BID (n=16). Median PFS was 15 months (range, 5-24). OS median, 16 months [95% CI = 9.59–22.4]. Among 24 evaluable patients, 20 (83%) had a partial response and 3 (12.5%) had stable disease by Response Evaluation Criteria In Solid Tumors criteria.
The most frequent drug-related adverse events (all grades) were diarrhea (32%), fatigue (58%), nausea (37%), vomiting (8.2%), neutropenia (12.5%), anemia (24.9%) and elevations in alanine aminotransferase (37.5%) and aspartate aminotransferase (31.2%). Dose-limiting toxicities (all grade 3 hepatic enzyme elevations) occurred only in 2/24 patients (8.3%). All hepatic enzyme elevations were reversible and manageable with dose reduction. No new safety signals were observed compared with the 2015 first analysis
Conclusion
Based on cohort result update, continuous treatment with second-line nintedanib combined with docetaxel was well tolerated and showed efficacy in Mexican patients with advanced non-small-cell lung cancer.
