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Rossana Ruiz
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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
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.04-46 - Immunotherapy at Any Line Improves Survival in Hispanic Patients with Advanced Metastatic NSCLC Compared to Chemotherapy (Quijote-CLICaP) (Now Available) (ID 2776)
08:00 - 18:00 | Author(s): Rossana Ruiz
- Abstract
Background
Immunotherapy for NSCLMC offers a significant advantage to chemotherapy in selected cases. This benefit starts to disapear as the patients start two progress and requiere change in medication or even chemotherapy. The objective of this study was to compare survival outcomes of patients with advanced or metastatic NSCLC who received immunotherapy at first, second or beyond versus matched patients receiving standard chemotherapy.
Method
A retrospective multicenter international cohort study of 296 patients with unresectable/ metastatic NSCLC treated with immunotherapy either as first, second, third or fourth line was conducted. A matched comparison with a historical cohort of first line chemotherapy was conducted.
Result
Median age was 64 years (Range 34-90) and 40.2% were female patients. 91.2% of patients had an ECOG performance score ≤ 1. Immunotherapy as first line was given to 39 patients (13.7%), second line to 140 (48.8%), and as third line and beyond to 108 (37.6%). Median overall survival was 19.9 months (95% CI 14.5-22.7 months) and progression-free survival was 3.73 months (95% CI 2.8-4.2). Factors associated with increased survival included treatment as first-line (p < 0.001), type of response (p < 0.001) and PD-L1 status (p = 0.0039). Compared with the historical cohort, immunotherapy proved to be superior in terms of OS (p= 0.05) but not PFS (p= 0.2).
Conclusion
Patients who receive immune checkpoint inhibitors as part of their treatment for NSCLC have better OS compared with matched patients treated with standard chemotherapy, regardless of treatment line.
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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
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.12-30 - Clinicopathological Features and Survival of Lung Neuroendocrine Tumors (ID 2865)
08:00 - 18:00 | Author(s): Rossana Ruiz
- Abstract
Background
Lung neuroendocrine tumors (NETs) are a heterogenous group of malignances classified into four histological types, being small cell lung cancer (SCLC) the most frequent and mortal. Due to the rarity of the disease, limited clinical data is available for NTEs. Herein we aim to describe the epidemiology, clinical features and survival of this group of neoplasms.
Method
This is a retrospective analysis of patients diagnosed with lung NETs between 2010 and 2014 at Instituto Nacional de Enfermedades Neoplasicas (INEN) in Lima, Peru. Demographic characteristics, possible predisposing factors, histological type and stage were collected from clinical files. Survival analysis was calculated with Kaplan-Meier method. Prognostic factors were analyzed with Cox regression method.
Result
We identified 69 patients with lung NETs, which corresponds to the 2.8% of lung cancers diagnosed in the same time period. Median age at diagnosis was 62 years and 59.4% of patients were male. Possible risk factors described were smoking history (50%) and familiar history of cancer (23.2%). Mean time from onset of symptoms to diagnosis was 3 months. Frequent symptoms at diagnosis were cough (75%), chest pain (59%), dyspnea (50%), weight loss (49%), hemoptysis (28%), hyponatremia (19.6%) and superior vena cava syndrome (13.8%). Between NETs, SCLC was the most common histological type (82.8%), followed by typical carcinoid (12.1%) and large cell neuroendocrine carcinoma (5.2%). Almost all patients (91.8%) had unresectable disease at diagnosis (21.3%, stage III; 70.5% stage IV) according TNM classification. Among SCLC, 60.4% had an extensive disease according to the IASLC classification, with extra thoracic compromise in bone (25.6%), brain (23.1%), suprarenal gland (21.1%) and liver (15.8%). The preferred systemic treatment was cisplatin/etoposide (93%) in the metastatic setting. The median overall survival for all histological types was 6.7 months (range 4.1 – 9.2) (Differences by histological grade in Table 1). Among clinical factors, weight loss at diagnosis emerged as a prognostic factor associated with survival of high-grade NETs (HR 3, 95% CI 1.6 – 5.5).
ConclusionI
II
III
IV
mOS
Carcinoids
40%
0%
30%
30%
87m (40.4 – 133.6)
High-grade NETs
8.8%
0%
21.1%
70.2%
4.5m (2.6 – 6.4)
Lung NETs have a heterogenous clinical presentation with unresectable disease at diagnosis in almost all cases. SCLC is the most frequent histology, however, this proportion regarding of the total cases of primary lung neoplasms is markedly lower than what is reported in the literature, probably to our lower frequency of smokers. The survival of this group of patients is poor in comparison to other series being weight loss at diagnosis an important prognostic factor in this series.
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EP1.15 - Thymoma/Other Thoracic Malignancies (ID 205)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 2
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.15-28 - Survival of Thymoma Is Extensive in Latin-American Patients: Results from Over 10 Years of Experience (CLICaP-LATimus) (ID 2936)
08:00 - 18:00 | Author(s): Rossana Ruiz
- Abstract
Background
Thymomas are a group of rare neoplasm of the anterior mediastinum. Due to their low incidence, large cooperative studies are required to evaluate outcomes. The objective of this study is to present the results and experience in treatment of this pathology in Latin-America.
Method
A retrospective multicenter cohort study was conducted by The Latin-American Consortium for the Investigation of Lung Cancer (CLICaP). Patients with histologically proven thymomas between 1997 and 2018 were included in the analysis. Variables including clinical, pathological and therapeutic outcomes were registered in a centralized manner.
Result
A total of 105 patients were included. Median age at diagnosis was 54 years old (20-84), and with 60% (n = 38) of the included patients were female. Only 11% (n=7) of the patients had an ECOG performance score >1. Twenty-four patients (22.9%, 95%CI 14.8-30.9) presented with pulmonary or distant metastatic involvement with a median of 2 metastatic sites. Furthermore, 21.9 % of patients (n=23, 95%CI 13.9-29.8%) concurrently presented myasthenia gravis. Surgery was performed in 55 patients (52.3%, 95%CI 42.8 – 61.9%), comprising of 15 tumorectomies, 37 thymectomies and 5 biopsies achieving an R0 resection rate of 78% (95%CI 67.3-89.1%). Adjuvant treatment in the form of either chemotherapy, radiotherapy or both was offered to 3(5%), 7(12.7%) and 5(9%) patients, respectively. Disease progression was documented in 10 cases (9%, 95%CI3.9-15.1%) of which 6 (60%) were locoregional, 1 (10%) distant progression and 3 (30%) both locoregional and distant. Median overall survival (OS) was estimated at around 139.5 months (95%CI 86.1-NA). Cox regression indicated that OS was significantly improved by resection (139.5 vs 25.7 months, HR 4.17 [95%CI 12.6-17.8 months]).
Conclusion
Survival in patients with thymomas continues to be very favorable, especially in patients who receive adequate local control. The benefit of adjuvant treatment in this setting remains unclear.
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EP1.15-29 - Real World Characterization and Treatment of Patients with Thymic Carcinoma: Lessons from a Latin-American Study (CLICaP-LATimus) (Now Available) (ID 2921)
08:00 - 18:00 | Author(s): Rossana Ruiz
- Abstract
Background
Thymic carcinoma is a rare tumor that represents a clinical challenge, especially in resource limited settings. The objective of the present study was to characterize patients who presented this disease in Latin-America.
Method
From 2014 until 2018, a multinational Latin-American cooperative retrospective cohort study was performed. Patients with histologically confirmed thymic carcinoma were included. Clinical, pathological and treatment variables were collected across 7 participating nations.
Result
A total of 31 patients were included. Median age at diagnosis was 58 years old (34-69), 48% (n=15) of individuals were women with all but 2 patients (6.5%) achieving an ECOG performance score <2. All patients debuted with Stage IV disease; 24 patients (66%, [95%CI 62-92%]) as stage IVa and 7 as stage IVb (33%, [95%CI 7-37%]) with a median LDH level of 396.5 U/L (153-1529 U/L) and a median of 2 metastatic sites. 13 (41.9%, [95%CI 25-59%]) patients received preoperatory treatment consisting of chemotherapy (n=8, 42%) and chemoradiotherapy (n=5, 16%). Among these patients only 4 (12.9%) were subjected to surgery, two of which underwent a tumorectomy and 2 a thymectomy. 28 (90%, [95%CI 79.9-100%]) received palliative chemotherapy either with sunitinib (n=7, 25%) or cytotoxic agents. Median overall survival (OS) was reached at 20.2 months (95%CI 19-NA months). Patients who received preoperative treatment had a significantly prolonged OS (17.6 vs 26 months, HR 2.93 [95%CI 1.04-8.27 months], p = 0.03).
Conclusion
Thymic carcinoma constitutes an aggressive disease that is often diagnosed in advanced stages. These results suggest that multimodal treatment can be beneficial even in locally advanced cases. Larger clinical trial validating these conclusions are warranted.
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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
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.04-81 - Characterization of Hispanic Patients Who Experienced Hyperprogression During Treatment for Advanced NSCLC with Immunotherapy (ID 2922)
09:45 - 18:00 | Author(s): Rossana Ruiz
- Abstract
Background
Immunotherapy related hyperprogression is poorly characterized in Latin American patients. In this study we sought to characterize and identify factors associated with the presentation of hyperporgression after initiation of immunotherapy in patients with advanced non-small cell lung cancer (NSCLC).
Method
A multicenter international retrospective study on 110 patients was conducted. Clinical variables as well as routine blood studies were recorded before initiation of treatment. Regression analysis was used to find associations. A random forest tree analysis (RFTA) based on continuous and discrete variables was used to subcategorize patients based on occurrence of hyperprogression.
Result
Median age was 64 years (Range 34-90) and 59.8 % were male patients. ECOG performance status was >1 on 8.8% of patients. Median overall survival was 12.7 months (95% CI 9.67-14 months) and progression-free survival of 4.27 months (95% CI 3.97-5.0). 44 hyperprogressors were documented (19.8%, [95%CI 14.5-25.1%]). Median time to progression was approximately 5 weeks after initiation of treatment. Factors associated included albumin and hemoglobin levels (p = 0.046 and 0.037 respectively), presence of CNS (p= 0.0009) and bone metastasis (p = 0.004) and weight loss (p= 0.004). RFTA revealed that a leucocyte count over 5.300 cells/dl was present in all hyperprogressors.
Conclusion
Hyperprogression is a phenomenon after initiation of immunotherapy which is associated with clinical and paraclinical variables. These associations could be used to withhold certain agents and prevent its occurrence in NSCLC treatment.
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P2.15 - Thymoma/Other Thoracic Malignancies (ID 185)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.15-12 - Epidemiology of Thymic Epithelial Tumors: 22-Year Experience from a Single-Institution (ID 2831)
10:15 - 18:15 | Author(s): Rossana Ruiz
- Abstract
Background
Thymic epithelial tumors (TETs) represents a heterogeneous group of rare neoplasms that represent, however, the most common entity of the anterior mediastinum. Epidemiological data and treatment options for these neoplasms are very limited.
Method
Retrospective study of TET diagnosed at Instituto Nacional de Enfermedades Neoplasicas (INEN) in Lima, Peru, from 1996 to 2018. Clinicopathological data was retrieved from clinical files. All cases were reviewed by a pathologist and reclassified according to the 2004 WHO classification system. Staging was performed with the Masaoka-Koga Staging System. Treatment and follow-up data were also collected. Survival curves were constructed with the Kaplan-Meier method.
Result
84 patients were included. Median age at diagnosis was 55 years old (range 19 to 84) and 51.8% were female. Most patients (95.2%) were in good status performance (Zubrod 0-2) and 36.5% were smokers. The histological type corresponded to thymoma (T) in 63.9% of cases (n=53) and to thymic carcinoma (TC) in 36.1% of cases. T were of type A, AB, B1, B2 and B3 in 15.8%, 19.7%, 3.2%, 3.9% and 7.9% of cases, respectively. The proportion of advanced disease (Masaoka stage III-IV) was higher in TC (89.6%) than in T (51.1%). The most common treatment modality was systemic chemotherapy for advanced disease in 37.3%. With a median follow-up of 88.4 months, median overall survival (OS) was 81.6 months for T and 12.3 months for TC (p=0.01). Survival according to different histological types is shown in table 1.
ConclusionHistological type
Median OS (months)
Thymoma A, AB, B1
102
Thymoma B2 – B3
16.7
Thymic carcinoma
12.3
The result of this study indicates a clear association between the WHO histological classification and Masaoka-Koga staging system with survival. We found a higher than expected proportion of T with advanced disease at diagnosis. The reasons behind this finding require further research. Being this a rare disease, collaboration is very important to foster knowledge and to promote prospective and randomized clinical trials focused on classification and treatment.
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P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 2
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.16-15 - Survival and Clinical Immunotherapy Outcomes in Hispanic Patients vs Non-Hispanic White Patients with Non-Small Cell Lung Cancer (Now Available) (ID 1514)
10:15 - 18:15 | Author(s): Rossana Ruiz
- Abstract
Background
The number of Hispanic (HISP) patients (pts) enrolled in immunotherapy (IMMUNO) trials is minimal or non-existent in non-small cell lung cancer (NSCLC). It’s well known that HISP pts with NSCLC have not only a different genomic profile than Non-Hispanic Whites (NHW)- like higher expression of EGFR mutations- but also better outcomes than NHW (“Hispanic Paradox”); thus the need to validate outcomes in HISP pts treated with IMMUNO.
Method
We present data in 436 NSCLC pts treated with IMMUNO at 5 large institutions (3 in the US, 2 in Latin America). The agents evaluated include: nivolumab, pembrolizumab and atezolizumab. 256 pts were HISP and 180 pts were NHW. Most of the pts were treated with single agent therapy as second line or beyond while a small group of pts were treated as first line. The primary endpoints of the study were: response rate (ORR), progression free survival (PFS) and overall survival (OS). Secondary endpoints were disease control rate (DCR), PD-L1 expression and others.
Result
The results are consolidated in the table below.
Hispanics (n=256)
NHW (n=180)
p value
Sex (males)
52%
45%
0.2059
ORR
First Line
35%
30%
0.6590
Second Line
18%
19%
0.3236
Adeno
22%
24%
0.6714
SQCC
24%
23%
1.0000
PDL1 (+)
29%
32%
0.4839
PDL1 (-)
5%
17%
0.3040
Disease Control Rate: ORR+SD (DCR)
Adeno
68%
67%
0.8989
SQCC
67%
46%
0.0777
Median PFS
4m
4m
0.7509
Median OS
22m
22m
0.2004
There were no statistical significant differences among HISP and NHW pts regarding ORR, DCR, PFS, OS, and responses according to PD-L1 status.
Conclusion
No significant differences were found in the clinical outcomes between these 2 ethnic groups despite the “Hispanic Paradox” and expected genomic differences; however pts with actionable mutations were excluded as they usually do not get IMMUNO as first or second line; an approach that might change after IMPOWER 150. This is the largest comparison of NSCLC immunotherapy outcomes in HISP vs NHW pts. These results are comparable to the ones seen in Checkmate and Keynote studies. As expected, higher response rates were seen in first line therapy and pts with PD-L1 (+) status. Further comparisons will be better addressed by a larger prospective study.
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P2.16-25 - Epidemiology of Advanced Lung Cancer in Peru (ID 2855)
10:15 - 18:15 | Author(s): Rossana Ruiz
- Abstract
Background
Epidemiology and survival data of lung cancer is scarce in Latin America. This information is essential to understand the regional burden that cancer represents and to design and implement targeted interventions for cancer control. Similarly to what happens in the rest of the world, most of our lung cancer patients present with advanced disease.
Method
Retrospective analysis of metastatic lung cancer cases diagnosed at Instituto Nacional de Enfermedades Neoplasicas (INEN) Lima-Peru between 2010 to 2014 were reviewed. Data was manually curated from clinical files.
Result
993 patients were included, corresponding to 85% of total lung cancer cases diagnosed within the same time period. Median age at diagnosis was 63 years old (range 20-91y) and 55% were females. 25% of patients had history of exposure to biomass fumes from cooking inside the house and 20% of patients were smokers. The histologic type was adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma and large cell carcinoma in 89.2%, 9.8%, 0.8% and 0.2% of the cases, respectively. The adenocarcinoma/squamous cell carcinoma ratio was 9/1. With a median follow-up of 78 months, median overall survival (OS) was 7 months. Median OS for adenocarcinoma, squamous cell carcinoma and adenosquamous carcinoma was 7, 6, and 5 months, respectively.
Conclusion
The epidemiological profile of lung cancer in Peruvian patients is unique as it is characterized by a younger age at presentation, a preponderance of females over males and a strikingly high frequency of adenocarcinomas. This may be in concordance with the low prevalence of tobacco smoking and the high prevalence of EGFR mutations previously reported for our population as well as with special exogenous exposures. The low survival could be partially attributed to the lack of access to targeted therapy during those years. The molecular characterization of this cohort of patients is ongoing.
