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Marco Antonio Galvez Nino



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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): Marco Antonio Galvez Nino

      • 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).

      I

      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)

      Conclusion

      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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    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): Marco Antonio Galvez Nino

      • 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.

      Histological type

      Median OS (months)

      Thymoma A, AB, B1

      102

      Thymoma B2 – B3

      16.7

      Thymic carcinoma

      12.3

      Conclusion

      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: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.16-25 - Epidemiology of Advanced Lung Cancer in Peru (ID 2855)

      10:15 - 18:15  |  Author(s): Marco Antonio Galvez Nino

      • 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.