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Gitte Fredberg Persson
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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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EP1.11-19 - Surveillance with PET/CT and ctDNA of Lung Cancer Patients After Completion of Definitive Therapy; A Randomized Trial (Now Available) (ID 2678)
08:00 - 18:00 | Author(s): Gitte Fredberg Persson
- Abstract
Background
Even after treatment with curative intent lung cancer patients have a high risk of relapse. Patients are currently followed with CT. However, after surgery and especially radiotherapy CT has limited accuracy potentially delaying the diagnosis of a relapse. There is a scarcity in evidence regarding the most efficient follow-up interval as well as maging method. Together with CT the use of PET/CT for follow-up has been increasing and there is a need for improved understanding and perhaps questioning of the role of imaging in surveillance. Relapse of tumour activity can also be reflected by shedding of tumour DNA (ctDNA) into the blood stream. Studies have shown increase in circulating ctDNA months before standard radiologic assessment. Blood sampling and subsequent analysis of ctDNA therefore represent a promising minimally-invasive strategy to assess genomic tumour material and follow its changes. The purpose of this on-going clinical trial is to improve early detection of lung cancer relapse enabling more patients to receive definitive treatment of their relapse, ultimately leading to improved survival.
Method
This national, randomized trial compares two strategies for surveillance of patients with non-small cell lung cancer treated with curative intent (figure 1): standard follow-up +/- imaging with FDG PET/CT. Primary endpoint is frequency of treatable relapse and secondary endpoints includes survival and quality of life, number and type of invasive procedures, adverse events and type of treatment after verification of relapse, as well as use of healthcare resources.Based on samples collected during this randomized trial we will evaluate if monitoring patients with ctDNA enable us to track cancer evolution and detect early signs of relapse, as well as exploring potential new stratification of patient cohort with focus on high-risk and low-risk groups. Hereby, designing an optimal surveillance strategy for individual patients.
Result
The trial has been starting gradually since end-2018 and is now including patients in 4/5 Danish regions. The study aims to include 750 patients by 2021. In order to obtain baseline blood sample for ctDNA patients are included both prior to treatment (by April 2019 n=61) and 3 months after treatment (only patients in complete remission, n=25).
Conclusion
SUPE_R will provide the scientific basis for implementing new ways for surveillance of patients with lung cancer as well as provide knowledge transferable to other groups of cancer patients. This is the first study considering bioinformatics and methodological aspects of liquid biopsies and relating them directly to imaging and clinical benefits for the patients.
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P1.04 - Immuno-oncology (ID 164)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.04-51 - Treatment with Immune Checkpoint Inhibitors for Advanced NSCLC in Elderly and Frail Patients. A Real-Life Experience (Now Available) (ID 1327)
09:45 - 18:00 | Author(s): Gitte Fredberg Persson
- Abstract
Background
Immune checkpoint inhibitors (ICIs) has changed the standard treatment in advanced stage non-small cell lung cancer (NSCLC). However, patients above 75 years and patients in performance status (PS) 2 are underrepresented in randomized clinical trials. Hence, the efficacy and safety of treatment in these large subgroups of patients remains unclear. We report a real-life study of such patients treated with immunotherapy in a second-line setting.
Method
Data from consecutive patients with advanced NSCLC who had 2nd line treatment with ICIs at the University Hospitals in Copenhagen during November 2015 to March 2019 were obtained from medical records. Treatment efficacy and safety was evaluated, and treatment related adverse events (AEs) were registered.
Result
A total of 224 NSCLC patients were treated with either nivolumab or pembrolizumab: The median follow up time of was 12.3 months. The median progression free survival (PFS) was 4.9 months, and median overall survival (OS) was 12.9 months CI [9.7-14.6]. The median age was 67.7 years, while 45 patients (20%) were 75 years or older. There were no significant difference when comparing patients ≥ 75 years vs. < 75 years with respect to PFS ( 5.3 vs. 4.9 months, p = 0.81) nor in OS (14.2 vs. 12.8 months, p = 0.93). PFS and OS were correlated with PS: The PFS was 7.7, 4.7 and 2.0 months (p = 0.0003) in PS 0, PS 1 and PS 2, respectively. OS was 20.9, 12.0 and 3.0 months (p > 0.0001) in PS0, PS1 and PS 2, respectively. AEs were reported in 183 patients (82%), among whom 44 patients (20%) experienced grade 3-5. There were no difference in AEs in younger patients compared to older ≥ 75 years (p = 0.18). The incidence of grade 3-5 AEs was significantly higher among patients in PS 2 (35%) compared to PS 0-1 (17%), (p < 0.001).
Conclusion
NSCLC patients ≥ 75 years had efficacy and safety profiles in second-line ICIs comparable to those of younger patients. However, treatment with ICIs in patients with PS 2 was associated with a significant lower PFS and OS. The high risk of seriously AEs in patients with PS 2 is of concern and warrants further investigation.
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P1.12 - Small Cell Lung Cancer/NET (ID 179)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.12-13 - The Past, Present, and Future of SCLC and NSCLC Incidence, Mortality, and Prevalence in Denmark During 2006 Through 2030 (ID 1144)
09:45 - 18:00 | Author(s): Gitte Fredberg Persson
- Abstract
Background
Information on the epidemiology of lung cancer and its main subtypes, small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC), is needed to assess the impact of lung cancer subtypes on the current and future health care system.
Method
Data from Danish nationwide registers were used to describe trends in lung cancer incidence, mortality, and prevalence in Denmark during the study period January 1, 2006 to December 31, 2015. Annual forecast on prevalence of lung cancer in Denmark up till 2030 was developed using projections of incidence rates from NORDCAN (http://www-dep.iarc.fr/NORDCAN/english/frame.asp) combined with forecasted mortality rates in the study patient population.
Result
A total of 44,291 lung cancer patients were identified in the Danish Cancer Registry during the study period, of which 6,353 (14.3%) had pathologically verified SCLC. Among the remaining cases ‘NSCLC+other’; 33,747 (89.0%) had verified NSCLC, 4,038 (10.6%) lacked pathology, and 153 (0.4%) had other pathology than indexed lung cancer. Among SCLC, the annual numbers of new cases and deaths were stable, and at similar levels (Figure 1). As a result, the SCLC prevalence was projected to remain at same stable level until 2030. Among NSCLC+other, the annual numbers of new cases increased gradually. The gap between new cases and deaths became greater during the study period due to slowly steadying number of deaths. Hereby, the observed prevalence of NSCLC +others grew exponentially and was projected to continue so.
Conclusion
The current and future epidemiological profiles differ according to lung cancer subtype. This finding should be considered when prioritizing and planning for future lung cancer care, particularly in the context of new treatment strategies, where personalized medicine and treatment modalities such as immunotherapy may result in improved prognosis. Further and continuous epidemiological monitoring is recommended to assess the impact of such improvements.
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P1.18 - Treatment of Locoregional Disease - NSCLC (ID 190)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.18-09 - Trimodal Treatment of Locally Advanced Non-Small Cell Lung Cancer: Model-Based Comparison with Chemoradiation Only (Now Available) (ID 784)
09:45 - 18:00 | Author(s): Gitte Fredberg Persson
- Abstract
Background
Standard treatment for patients with locally advanced non-small cell lung cancer (LA-NSCLC) is chemoradiation (CRT). Some patients with minimal N2 disease are offered surgery after CRT (trimodal treatment) but evidence is sparse.
In our institution patients were possible candidates for trimodal treatment if they were fit for surgery and had minimal N2 disease or poor local response to CRT.
We evaluate the outcome of trimodal treatment compared to CRT alone using a model-based comparison.
Method
Patients with LA-NSCLC treated with CRT with a radiation dose of 60-66 Gy from 2013-18 were eligible. We registered patient and disease characteristics, treatment outcome and survival. For the trimodal patients we registered complications and postoperative mortality[IRV1] [GP2] .
A multivariable model was generated based on data from CRT treated patients to provide an expected survival given the covariables: Age, T- and N-stage, histology, performance status and Charlson Comorbidity Score. The model provided expected survival for trimodality patients and observed outcome was compared to CRT.
Result
Two-hundred-sixty-six patients were included. Forty-one received trimodal treatment. Patient characteristics are shown in the table. Median time from CRT to surgery was 10 (5-113) weeks. Video assisted thoracic surgery was performed in 36.5% and open surgery in 63.4% of cases. Postoperative complication rate was 51.2%, most commonly infection (29.3%) and bleeding (12,2%). Reoperation rate was 17.1%. 30- and 90-day mortality was 7.3%. Complete pathological response after CRT was seen in 26.8% of cases.
In univariate analysis, trimodality patients had improved survival (p=0.01) as compared to CRT. Adjusting for available covariables, the observed survival tended to remain superior to the expected survival if CRT was given (Figure). In the multivariate model thirty-six patients including two cases were excluded as comorbidity score was missing.
Conclusion
Trimodal treatment appears to improve survival, but residual confounding from case selection is a limitation.
