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Sergio Martínez Recio
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EP1.06 - Mesothelioma (ID 196)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Mesothelioma
- Presentations: 3
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.06-02 - Association of Inflammatory Biomarkers with Overall Survival in Patients with Advanced Malignant Pleural Mesothelioma (Now Available) (ID 1964)
08:00 - 18:00 | Author(s): Sergio Martínez Recio
- Abstract
Background
The inflammation process has been proposed as a mechanism of immunoresistance in patients with cancer, promoting cancer growth and dissemination. Derived neutrophil to lymphocyte ratio (dNLR) greater than 3 and lactate dehydrogenase (LDH) level greater than upper limit of normal (ULN) are associated with poor outcomes in patients with advanced non–small cell lung cancer. The aim of this study is to determine whether pretreatment levels of dNLR and LDH as well as PD-L1 status are associated with overall survival in patients with malignant pleural mesothelioma.
Method
We conducted a retrospective study, which included all patients with malignant pleural mesothelioma diagnosed in a tertiary referral hospital from December 2009 to March 2019. PDL1 status, complete blood cell counts and LDH levels were collected. A descriptive analysis was carried out, followed by a survival analysis using the Kaplan-Meier estimator.
Result
We selected 25 patients. No correlation was found between dNLR and LDH levels. 5 patients (20%) had a dNLR greater than 3, of which 3 patients had stable disease and 2 patients received supportive care. Patients with a dNLR greater than 3 had a median overall survival (mOS) of 8,5 months, whereas patients with a dNLR less than 3 had a mOS of 17,0 months, with statistically significant differences (P:0.038). 2 patients (8%) had a LDH level greater than ULN, of which 1 patient achieved a partial response and 1 patient had stable disease. Regarding the LDH level no difference in overall survival was found.
Regarding to the PD-L1 status, 10 (40%) of 25 patients had PD-L1 ≥ 1%, 8 (32%) had PD-L1 < 1% and 7 (28%) had unknown PD-L1. Patients with PD-L1 ≥ 1% had a mOS of 8,5 months, whereas patients with PD-L1 <1% had a mOS of 15,7 months, with no statistically significant association (P> 0.05).
Conclusion
In our sample, pretreatment levels of dNLR greater than 3 were correlated with worse overall survival in patients with malignant pleural mesothelioma. Furthermore, pretreatment levels of LDH greater than ULN and PD-L1 greater than or equal to 1% could be correlated with worse overall survival, although due to the size of our sample we are not able to conclude statistical significance. Further studies are needed to explore this relationship.
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EP1.06-09 - Mesothelial Tumors Registry in Spain: A Retrospective Multicenter Study (Now Available) (ID 2327)
08:00 - 18:00 | Author(s): Sergio Martínez Recio
- Abstract
Background
Malignant mesothelioma is an unusual tumor associated with poor prognosis. Currently, there are no effective treatments after the progression to the first line. The aim of this study is to analyze the experience in 7 spanish centers.
Method
We conducted a retrospective analysis including patients with malignant mesotheliomas of 7 centers in Spain. Demographic, clinical and pathological variables, tumor response, progression date and death were collected.
Result
We enrolled 63 patients with diagnosis of malignant mesothelioma. The average age was 70 years. 73,4% were men and 26,4% women. The most frequent location was the pleural (78,1%) and biopsy was the main diagnostic method (92,2%). 76,6% were diagnosed as epitheloid mesothelioma subtype, whereas sarcomatoid and mixed subtypes were less frequent. Tumor in stage IV was presented at diagnosis in 75 % cases. The most frequent first treatment was chemotherapy, 95,2% of patients received treatment based on platinum doublet with pemetrexed, followed by pemetrexed maintenance. Best response was partial response in 20,6% , stable disease in 41,3% , complete response in 22,2% and progressive disease in 15,9%.The median progression free survival of the sample was 8,8 months, and the median overall survival was 12 months.
Conclusion
The demographics and baseline characteristics as well as the survival data obtained in our sample are consistent with the previously reported.
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EP1.06-11 - Advanced Malignant Pleural Mesothelioma: A Single Institution Experience (Now Available) (ID 1993)
08:00 - 18:00 | Author(s): Sergio Martínez Recio
- Abstract
Background
Malignant pleural mesothelioma is a rare and highly aggressive tumor that typically presents with advanced disease. The prognosis of patients with malignant pleural mesothelioma is poor and there is currently a lack of effective treatment options. The aim of this study is to analyze the experience of our center in the management of this pathology.
Method
We conducted a retrospective study, which included all patients with malignant pleural mesothelioma diagnosed in a tertiary referral hospital from December 2009 to March 2019. Data regarding baseline characteristics, treatment response and survival were collected. A descriptive analysis was carried out, followed by a survival analysis using the Kaplan-Meier estimator.
Result
We selected 25 patients. Table 1 summarizes the main sociodemographic characteristics, the histological subtype and the stage.
Table 1 Nº (%) Sex: Male/Female
19 (76%) / 6 (24%) Age (years):
71 (51 – 89)
Histology:
– Epithelioid mesothelioma
– Sarcomatoid mesothelioma
– Mixed mesothelioma22 (88%)
1 (4%)
2 (6%)Stage:
– Stage III
– Stage IV4 (16%)
21 (84%)22 (88%) of 25 patients received first line chemotherapy with platinum doublet with pemetrexed followed by pemetrexed maintenance and 3 (12%) received palliative care. The proportion of patients who received six cycles of platinum doublet with pemetrexed was 55%. 5 (20%) of 22 patients who received first line chemotherapy with platinum doublet with pemetrexed achieved a partial response, 15 (60%) had stable disease and 2 (8%) experienced disease progression.
After a median follow-up duration of 15,17 months, 19 (76%) patients had died. The median progression free survival was 13,1 months (IC 95%: 6,7 – 19,5), and the median overall survival was 15,7 months (IC 95%: 11,3 – 20,0). The major cause of death was cancer in 18 patients (95%) and 1 patient dead of heart disease.
Conclusion
Demographics and baseline characteristics as well as the survival data obtained in our sample are consistent with the previously reported. Further studies are needed to determine other treatment options to improve the prognosis of these patients.
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EP1.18 - Treatment of Locoregional Disease - NSCLC (ID 208)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.18-28 - Neoadjuvant Therapy Among Patients Undergoing Resection for Non-Small-Cell Lung Cancer: A Single Institution Experience (Now Available) (ID 2002)
08:00 - 18:00 | Author(s): Sergio Martínez Recio
- Abstract
Background
Lung cancer is the leading cause of cancer deaths worldwide. Surgery alone results in poor overall survival in patients with stage III non-small cell lung cancer (NSCLC). Neoadjuvant therapy offers the ability to treat micrometastatic tumor cell dissemination preoperatively and increased resectability due to tumor regression. The aim of this study is to analyze the experience of our center and to identify clinical and pathological characteristics related to greater relapse-free survival (RFS).
Method
We conducted a retrospective study, which included all patients with NSCLC treated with neoadjuvant therapy follow by surgery in a tertiary referral hospital from April 2013 to March 2019. Data regarding clinical and pathological characteristics, treatment response, type of surgery and survival were collected.
Result
We selected 10 patients. Table 1 summarizes the main sociodemographic characteristics, the histological subtype, the stage, the regimens of neoadjuvant therapy and the types of surgery.
Table 1 Nº (%) Sex: Male/Female 6 (60%) / 4 (40%) Age (years): 62 (44 – 77) Performance status:
– 0
– 16 (60%)
4 (40%)Smoking:
– No
– Yes1 (10%)
9 (90%)Weight loss before diagnosis:
– High (≥5%)
– Low (<5%)1 (10%)
9 (90%)Histology:
– Squamous cell carcinoma
– Adenocarcinoma
– Large-cell cancer3 (30%)
6 (60%)
1 (10%)Stage:
– Stage IIIA
– Stage IIIB6 (60%)
4 (40%)Node status:
– N0
– N1
– N23 (30%)
1 (10%)
6 (60%)ALK translocation:
– No
– Yes
– Unknown8 (80%)
0 (0%)
2 (20%)EGFR mutation:
– No
– Yes
– Unknow8 (80%)
0 (0%)
2 (20%)Percentage of PD-L1 at diagnosis:
– < 1%
– 1 – 49%
– ≥ 50%
– Unknow5 (50%)
1 (10%)
2 (20%)
2 (20%)Neoadjuvant therapy regimens:
– Platinum – pemetrexed
– Platinum – vinorelbine
– Platinum – paclitaxel – bevicizumab
– Platinum – vinorelbine – gemcitabine
– Platinum – paclitaxel – nivolumab5 (50%)
1 (10%)
1 (10%)
1 (10%)
2 (20%)Types of surgery:
– Lobectomy
– Bilobectomy
– Pneumonectomy6 (60%)
1 (10%)
3 (30%)Percentage of PD-L1 after neoadjuvant therapy:
– < 1%
– 1 – 49%
– ≥ 50%
– Pathological complete remission
– Unknow2 (20%)
1 (10%)
4 (40%)
2 (20%)
1 (10%)Regarding tumour response rates after neoadjuvant chemotherapy, 2 (20%) of 10 patients achieved a complete response and 8 (80%) achieved a partial response. Furthermore, 5 (71%) of 7 patients with mediastinal lymph node involvement achieved a nodal downstaging. Using the Wilcoxon signed-rank test, there are statistically significant differences in the stage of the patients before and after the neoadjuvant chemotherapy (Z: -2,82, p:0,005).
After a median follow-up duration of 38 months, 5 (50%) patients had relapsed. The median RFS was 22 months (IC95%: 2–41). We did a multivariate logistic regression analysis, in which no statistically significant associations were found between clinical and pathological characteristics studied and the RFS (p>0,05).
Conclusion
Neoadjuvant therapy followed by surgery should be considered as standard treatment for a selective group of patients with stage III of NSCLC, in our sample all patients yielded excellent results. In the multivariate analysis no statistically significant associations were found due to the small size of our sample.
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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
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.01-130 - Clinical Experience with Nintedanib in Previously Treated Non-Small Cell Lung Cancer in Spain: A Retrospective Multicenter Study (Now Available) (ID 2260)
09:45 - 18:00 | Author(s): Sergio Martínez Recio
- Abstract
Background
Lung cancer is the leading cause of cancer deaths worldwide. Nintedanib is a triple angiokinase inhibitor approved with docetaxel for non-small cell lung cancer after chemotherapy. The aim of this study is to analyze the efficacy and safety of nintedanib in combination with docetaxel in patients treated in various Spanish centers.
Method
We conducted a retrospective multicenter study, which included all patients with non-small cell lung cancer who received nintedanib with docetaxel in second o third line of treatment.
Result
We enrolled 124 patients from ten different Spanish centers. The male –female ratio was 3:2, with an average age of 62 years. 82,7% were smokers, 12,2% never smokers and 5,7% former smoker. The most frequent histology was adenocarcinoma (97,6%) and respect mutational state only 5 patients were EGFR mutate and 1 patient presented ALK translocation. PDL1 status was unknown in 46,3% of cases, negative in 32,5% and positive in 21,1%. The majority of patients were diagnosis in stage IV (74%) and in stage III (13,8%). In the first line, 98,4% had received platinum-based chemotherapy and 40,7 % had received previous bevacizumab therapy with an average of 4,1 cycles.
The average of nintedanib cycles was 6 and the median time of treatment was 496 days. 65,9% of patients included had progressed to the first line in less than 9 months. The disease control rate was 61% (25,2% stable disease, 34,1% partial response and 1,6% complete response). Progression free-survival was 4,1 months and the overall survival was 26,9 months. The most common adverse events were: fatigue ( 82,1%), diarrhea (63,4%), nausea (32,5%), neutropenia (33,3%) and cough (18,2%). Thirty-one patients (25,2%) required dose adjustment (15 patients decrease to 200 mg daily and 18 patients to 300 mg daily).
Conclusion
The efficacy and safety of nintedanib in our cohort is similar to the previously reported. Nintedanib in combination with docetaxel is an effective treatment option for patients with advanced non-small cell lung cancer.
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P2.01 - Advanced NSCLC (ID 159)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 2
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.01-55 - Immunotherapy First or After Nintedanib?: A Spanish Experience (Now Available) (ID 2308)
10:15 - 18:15 | Author(s): Sergio Martínez Recio
- Abstract
Background
Anti PD-1 and PD-L1 immunotherapies have demonstrated improved survival as second line treatment of patients with advanced lung cancer, and actually, this is a standard of care. In addition, Nintedanib-docetaxel is an option for few patients, and have demonstrated efficacy in second line treatment after platinum-based chemotherapy. The doubt is if immunotherapy could be change efficacy of nintedanib-docetaxel treatment.
Method
We conducted a retrospective multicenter study, which included all patients with non-small cell lung cancer who received nintedanib with docetaxel in second o third line of treatment. The objective of this study was to determine the efficacy of the nintedanib-docetaxel combination before and after immune checkpoint inhibitors.
Result
We enrolled 120 patients from 10 different Spanish centers. 72.4% had not received previous immunotherapy, while 27.6% had received it. Of those who had received previous immunotherapy: 10.6% received pembrolizumab, 10.6% received nivolumab and 3,3% received atezolizumab. Receiving previous immunotherapy had no impact on the PFS (4.5 months vs 3.2 months) or on the OS of the patients (25 months vs 20 months). Best response was partial response in 11 patients, stable disease in 11 patients and progressive disease in 10 patients. After the progression to nintedanib/docetaxel, 21.9% received immunotherapy. 15 patients received nivolumab, 10 patients atezolizumab and 2 patients pembrolizumab. Best response was partial response in 13 patients, stable disease in 5 patients, complete response in 1 patient and progressive disease in 8 patients. Subsequent treatment with immunotherapy was not associated with increased SLP or OS in our study.
Conclusion
Our experience suggests that the efficacy of nintedanib-docetaxel treatment is not modified by the treatment of previous or subsequent with immunotherapy.
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P2.01-81 - Predictive Factors of Survival in Patients Treated with Nintedanib: A Multicenter Retrospective Spanish Study (Now Available) (ID 2275)
10:15 - 18:15 | Author(s): Sergio Martínez Recio
- Abstract
Background
Nintedanib is a triple angiokinase inhibitor that blocks the proangiogenic pathways mediated by vascular endothelial growth factor receptors, platelet-derived growth factor receptors and fibroblast growth factor receptors. Nintedanib in combination with docetaxel is indicated for adults with adenocarcinoma metastatic lung cancer after chemotherapy. Although, as in other antiangiogenic therapies, we do not have a predictive response marker. The aim of this study is to analyze probably factors that influence in the response to the nintedanib-docetaxel scheme.
Method
We conducted a retrospective multicenter study, which included all patients with non-small cell lung cancer who received nintedanib with docetaxel in second or third line of treatment. Explorative analyses were conducted according to therapy antiangiogenic previous, status PDL1, nintedanib or docetaxel dose adjustment and time to treatment fail in previous line (> 9 months or < 9 months) , age, sex and smoking.
Result
We enrolled 124 patients from 10 different Spanish centers. Progression free-survival was 4,1 months and the overall survival was 26,9 months. Of the factors studied, only the dose adjustment of docetaxel during treatment (5,7 months vs 2,7 months, p<0,05) and the dose adjustment of nintedanib ( 7,2 months vs 4,7 months, p<0,05 ) were associated with an increase in PFS. The dose adjustment level of nintedanib (100 mg vs 150 mg twice) did not reach statistical significance. The only factors that achieved statistical significance in overall survival were progression to the first line> 9 month (36,5 months vs 19,3 months, p <0.05) and the dose adjustment of nintedanib (37 months vs 22 months, p < 0.05). Therapy antiangiogenic previous, status PDL1, age, sex and smoking did not increase survival.
Conclusion
In our study, nintedanib- docetaxel concluded significant OS benefits in adenocarcinoma lung cancer patients with time to relapse to first line >9 months and in patients with dose adjustment during treatment. Further studies are needed to verify this data.
