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MARTIN Lazaro
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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
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.04-06 - Analysis of the Relationship Between Ratio N / L and Survival in Patients Treated with Immunotherapy in Lung Cancer (ID 2605)
08:00 - 18:00 | Author(s): MARTIN Lazaro
- Abstract
Background
The neutrophil-lymphocyte (N / L) ratio is a marker of general immune response in different stress situations, having shown a relationship between the quotient and the evolution of patients treated with immunotherapy (IT), emphasizing the importance of inflammation in these patients.
Method
In order to evaluate this relationship in a context of usual clinical practice, a retrospective review of patients with pulmonary neoplasia who received IT treatment in the first line or successive, between November 2015 and December 2018, excluding those who received treatment within of ±±clinical trial. Data were collected from the clinical history of each patient, with special attention to baseline neutrophil and lymphocyte numbers, objective response to therapy by criteria iRECIST 1.1 after 3 months of treatment and overall survival (OS) defined from the beginning of treatment until death by progression of the disease.
Result
92 patients (29 women and 63 men) were analyzed with a mean age of 64 ±8 years.
15 (16,3%) patients received immunotherapy as first line treatment, 65.2% (60 patients) received it as 2nd line and 18,4% (17 patients) as 3rd or succesive lines. The average number of cycles received was 14 (1-52).
Two stretches of baseline N / L ratios ≤5 (low) and > 5 (high) were defined. Low ratio N / L (≤5) was identified in 62p (67.4%) of the patients treated with IT and high ratio N/L (> 5) in 30p (32,6%).
Of the 62 patients with a low ratio: 41 patients (66.1%) had some type of response or stabilization of their disease, 13 patients (21%) had progression and 8 patients (12.8%) received less than three months of treatment, 6 patients for PS deterioration and the other 2 patients continue with the treatment and are pending reevaluation.
Among the 30 patients patients with high N / L quotient: 7 patients (23.3%) presented response or stabilization of the disease, 23 patients (76,7%) presented progression or treatment was interrupted due to deterioration of the ECOG.
The average survival in the group with a low N / L ratio (≤5) was 213 weeks compared to the group with a high N / L ratio (> 5) 144 weeks (p <0.05).
Conclusion
The N / L ratio has been identified in some studies as an adverse prognostic factor in patients treated with IT. Our data from the usual clinical practice support this theory. If these findings are confirmed in future studies, it could be used as a response biomarker for better patient selection.
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EP1.14 - Targeted Therapy (ID 204)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Targeted Therapy
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.14-15 - Real World Clinical Experience of the Galician Lung Cancer Group: Afatinib in Patients with EGFR Positive Mutation (Now Available) (ID 1132)
08:00 - 18:00 | Author(s): MARTIN Lazaro
- Abstract
Background
Treatment with tyrosine kinasa inhibitors has been a revolution for the patients with non-small cell lung cancer and EGFR positive mutation, especially in patients with exon 19 deletions. Afatinib seems one of the best options of treatment.
Method
Retrospective study on patients from differents hospitals in Galicia (Spain) diagnosed of metastasic lung adenocarcinoma with EGFR positive mutation who have received first line treatment with afatinib between July 2015 and September 2018 were included. Main objective was to compare our clinical experience concerning response rate, progression free survival and toxicity with published data.
Result
45 caucasians patients were included in our analysis (33 women, 12 men). Median age was 71.2 years (range 39-91 years) and 29 patients had never smoked. Exon 19 deletion was the most common mutation (41 patients, 91.1%). The objective overall response was 68.9% (95% CI: 82.4-55.3), complete responses were observed in 6 patients (13.3%) and partial responses were found in 25 patients (55.6%). Stable disease was observed in 8 patients (17.8%) and disease progression in 1 patient (2.2%), 5 patients have not been reevaluated (11.1%). Median progression free survival (PFS) was 27 months (95% CI: 14.8-39.1) and overall survival was not reached. Common adverse events grade 3/4 were mucositis and skin toxicity in 11 patients (24.4%) and diarrhea in 6 patients (13.3%), respectively. The dose was reduced in 28 patients (62.2%) and treatment was discontinued in 8 patients (17.8%) owing to adverse events.
Conclusion
Median PFS in our patients is 15 months longer than the information retrieved from differents studies with similar response rates and toxicity. This might be due to a majority of population with exon 19 deletion which, according to published data, seems to benefit more from afatinib than from other EGFR mutations.
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P2.14 - Targeted Therapy (ID 183)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.14-63 - Cost Analysis of the Management of CNS Metastases in Patients with Advanced ALK+ NSCLC: Alectinib vs Crizotinib (ID 2174)
10:15 - 18:15 | Author(s): MARTIN Lazaro
- Abstract
Background
The high prevalence of CNS metastases in ALK+ NSCLC leads to a significant clinical and economic burden. Alectinib demonstrated superior CNS activity and significantly delayed CNS progression versus crizotinib in untreated patients. Therefore, alectinib could reduce the brain metastasis-related healthcare resource utilization and costs.
The objective is to estimate the cost associated with the management of patients with advanced ALK+ NSCLC with and without CNS metastases, and to perform an analysis of the annual cost comparing patients treated with alectinib or crizotinib.
Method
Using the disaggregated consumption of resources provided by a panel of expert oncologists, the cost/year of the management of patients with ALK+ NSCLC with/without development of CNS metastases was estimated.
The cost of management (€,2018) included the quantification of medical visits, hospitalisations, diagnostic and laboratory tests, imaging techniques and radiotherapy procedures.
The unit costs of the resources were obtained from eSalud (Spanish database).
Using the 12-month cumulative incidence rate of CNS metastases in the ALEX trial for alectinib (9.4%) and crizotinib (41.4%), the annual cost of management with each therapy was estimated and compared.
An alternative analysis was performed considering the management of adverse events (AE) observed in the ALEX trial, with costs obtained from the literature.
Result
The cost/year of managing NSCLC was €6,173.42/patient without CNS metastases and €21,637.50/patient with CNS metastases.
In patients treated with alectinib, the average cost per patient was lower than in patients with crizotinib (-€4,948.51 patient/year) in the Spanish healthcare setting.
Considering the cost of AE, the average cost/year difference would be -€5,044.26/patient treated with alectinib vs crizotinib.
Conclusion
The delay in the appearance of CNS metastases associated with the treatment of alectinib vs crizotinib may result in a reduction in cost per year in the management of ALK+ NSCLC. Comprehensive approach of cost analysis should be adjusted to each disease characteristics.
