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Diego Armando Diaz-Garcia
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P2.08 - Oligometastatic NSCLC (ID 172)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Oligometastatic NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.08-04 - Stereotactic Ablative Radiation Therapy to Lung Metastases Associates with Better Outcomes in Oligometastatic Lung Cancer: Prospective Study (Now Available) (ID 2919)
10:15 - 18:15 | Author(s): Diego Armando Diaz-Garcia
- Abstract
Background
Nearly 7% of stage IV Non-Small cell Lung Cancer (NSCLC) patients present oligometastatic disease at diagnosis. These patients can benefit from definitive treatment to primary tumour and loco-ablation of metastases. The use of stereotactic ablative radiotherapy (SABR) has demonstrated high rates of local control and survival improvement in early disease stage. The aim of this study is to evaluate Progression Free Survival (PFS), Overall survival (OS) and toxicity of patients with oligometastatic NSCLC treated with Stereotactic ablative radiotherapy (SABR) to lung metastases.
Method
A prospective study was conducted with oligometastatic NSCLC patients. From August 2014 to April 2019, with a median follow up of 13 months, forty-seven patients were enrolled. All patients received systemic therapy according to international guidelines. Then, patients without progression to systemic treatment, received SABR to lung metastases (30-60 Gy in 2-8 fractions) to the thoracic lesion (primary or metastatic) depending on location, size and number of lesions, always keeping BED (Biologically Effective Dose) >100 Gy at isocenter. This study was approved by Ethic and Research comitees at Instituto Nacional de Cancerología (CEI/799)(013/014/ICI).
Result
Most patients were women (59.6%), with a mean age of 58.9 years. Although two-thirds of patients were ever smokers (66.0%), most of them were light smokers. The most common histology was adenocarcinoma (87.2%). Contralateral lung was the most common metastatic site (40.4%). Half of the patient harbour at least one mutation, EGFR Exon 19 deletion was the most frequent mutation (38.3%). Patients received chemotherapy and EGFR-TKIs as 1st-line treatment in the 61.1% and 38.9%, respectively. All patients received SABR, response to treatment was as follows: disease control rate was 91.5%, partial response 14.9% and complete response 63.8%. Among those with disease progression, median time to systemic progression after SABR treatment was 5.4 months (95% 2.4-8.9 months). PFS since beginning of any treatment was not reached, since only 18 patients (38.3%) had disease progression. Until now only 4 patients (8.5%) had died, thus OS is not reached. Radiographic pneumonitis was observed in 72.2% (13 patients). Grade 1, 2 and 3 pneumonitis were observed in the 69.2% (9/13), 7.7% (1/13) and 23.1 (3/13) of the patients with pneumonitis.
Conclusion
SABR is a suitable and has a moderate toxicity profile. SABR is a therapeutic option for patients with oligometastatic NSCLC. SABR have shown to improve local control and increase progression-free survival. Future clinical trials are required to evaluate SABR against other treatment modalities.
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P2.09 - Pathology (ID 174)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Pathology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.09-28 - Prognostic Impact of LKB1 Expression in Advanced Non-Small-Cell Lung Cancer (Now Available) (ID 1528)
10:15 - 18:15 | Presenting Author(s): Diego Armando Diaz-Garcia
- Abstract
Background
LKB1 is a tumor suppressor gene that regulates cell energy homeostasis, cell polarization, and apoptosis. Within lung cancer, LKB1 ranks as the third most common mutation found in lung adenocarcinoma, both alleles are somatically inactivated in 30%. LKB1 mutations are linked to smoking history, moreover, it have been associated with more aggressive clinical phenotype in KRAS-mutant NSCLC patients, according to preclinical models. Additionally, LKB1 has been associated with primary resistance to PD-1 axis inhibitors in lung adenocarcinoma. However, its expression and clinical implication has not been extensively studied. The aim of the study was to evaluate LKB1 expression in patients with advanced NSCLC.
Method
In retrospective way patients with advanced NSCLC with and without EGFR mutations from México and Colombia were analyzed. Patients received therapy according EGFR status (TKI anti-EGFR or chemotherapy). Inclusion criteria were a histopathological confirmed diagnosis, adequate tissue to determine the expression of LKB1 by immunohistochemistry through the clone HPA017254 (Sigma®). The primary outcome was overall survival (OS).
Result
A total of 87 patients were included in the analysis, 25.3% of them had LKB1 positive expression. Median score intensity was 20%. There was a significant association of LKB1 positive expression with wood-smoke exposure (76.9 vs 23.1%, p=<0.001), EGFR mutation (54.5 vs 45.5%, p=<0.001) compared to LKB1 negative. Global Median OS was 29.7 months. Median OS for LKB1 positive was 33.3 months (CI 95%, 8.9 - 57.6) and 29.5 months (CI 95%, 26.1 - 32-8) for LKB1 negative (p=0.42). After stratifying patients by percentage of LKB1 expression, cut-off of 20% showed a tendency to increase OS in patients with ≥20% expression (figure 1); 49.9 months (IC 95%, 10.6 - 85.2 months) vs 29.5 months (IC 95%, 26.3 - 32.7 months), (p=0.068). Furthermore, a similar trend in OS was observed in patients with ≥50% expression, median OS was not reached compared with 29.5 months (IC 95%, 26.2 - 32.7 months) in patients with <50% expression (p=0.091).
Conclusion
We found a trend to higher OS in patients with LKB1 expression >20%. This data should be confirmed in prospective study in order to determine the role of LKB1 as biomarker in NSCLC patients.
